Correction of Anemia — Payoffs and Problems

Anemia develops in most patients with chronic kidney disease, historically often requiring transfusion, with obvious risks. With the advent of recombinant erythropoietin in the late 1980s, it became possible to treat anemia without transfusion, ushering in a new era. It soon became clear that additional considerations were important, such as ensuring adequate iron stores, providing sufficient folate and vitamin B12, and identifying other conditions affecting the hemoglobin level. How best to administer erythropoietin — as well as how best to produce it, given cases of pure red-cell aplasia related to production and administration — were also identified as . . .