scholarly journals Evaluation of recombinant human erythropoietin responsiveness by measuring erythrocyte creatine content in haemodialysis patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shun Hasegawa ◽  
Seishi Nakamura ◽  
Tetsuro Sugiura ◽  
Yoshiaki Tsuka ◽  
Nobuyuki Takahashi ◽  
...  
Keyword(s):  
Rapid Change ◽  
Haemoglobin Concentration ◽  
Resistance Index ◽  
Important Variable ◽  
Chi Square ◽  
Entire Study ◽  
Human Erythropoietin ◽  
Logistic Analysis ◽  
Erythropoietin Resistance Index ◽  
Relative Deficiency

Abstract Background One of the main causes of anaemia in patients with end-stage renal disease is relative deficiency in erythropoietin production. Eythropoiesis stimulating agent (ESA), a potent haematopoietic growth factor, is used to treat anaemia in haemodialysis patients. The effect of ESA is usually assessed by haematological indices such as red blood cell count, haemoglobin concentration and haematocrit, but erythrocyte indices do not provide information of the rapid change in erythropoietic activity. As erythrocyte creatine directly assess erythropoiesis, the aim of this study was to evaluate the effect of ESA in haemodialysis patients by measuring the erythrocyte creatine content. Methods ESA dose was fixed 3 months prior to the enrollment and was maintained throughout the entire study period. Erythrocyte creatine was measured with haematologic indices in 83 haemodialysis patients. Haemoglobin was also measured 3 months after. Results ESA dose (152.4 ± 62.9 vs. 82.2 ± 45.5 units/kg/week, P = 0.0001) and erythrocyte creatine (2.07 ± 0.73 vs. 1.60 ± 0.41 μmol/gHb, p = 0.0003) were significantly higher in 27 patients with haemoglobin <10 g/dL compared to 56 patients with haemoglobin ≥10 g/dL. There was a fair correlation between ESA dose and the concentration of creatine in the erythrocytes (r = 0.55, P < 0.0001). Increase in haemoglobin (>0.1 g/dL) was observed in 37 patients, whereas haemoglobin did not increase in 46 patients. Erythrocyte creatine levels were significantly higher in those patients with an increase in haemoglobin compared to those without (2.04 ± 0.64 vs. 1.52 ± 0.39 μmol/gHb, p < 0.0001). When 8 variables (ESA dose, erythropoietin resistance index, C-reactive protein, intact parathyroid hormone, iron supplementation, presence of anaemia, erythrocyte creatine and reticulocyte) were used in the multivariate logistic analysis, erythrocyte creatine levels emerged as the most important variable associated with increase in haemoglobin (Chi-square = 6.19, P = 0.01). Conclusion Erythrocyte creatine, a useful marker of erythropoietic capacity, is a reliable marker to estimate ameliorative effectiveness of ESA in haemodialysis patients.

scholarly journals Evaluation of Recombinant Human Erythropoietin Responsiveness by Erythrocyte Creatine in Haemodialysis Patients

2021 ◽  
Author(s):  
Shun Hasegawa ◽  
Seishi Nakamura ◽  
Tetsuro Sugiura ◽  
Yoshiaki Tsuka ◽  
Nobuyuki Takahashi ◽  
...  
Keyword(s):  
Recombinant Human Erythropoietin ◽  
Rapid Change ◽  
Haemoglobin Concentration ◽  
Resistance Index ◽  
Important Variable ◽  
Chi Square ◽  
Entire Study ◽  
Human Erythropoietin ◽  
Logistic Analysis ◽  
Erythropoietin Resistance Index

Abstract Background: One of the main causes of anaemia in patients with end-stage renal disease is relative deficiency in erythropoietin production. Recombinant human erythropoietin (rHuEpo), a potent haematopoietic growth factor, is used to treat anaemia in haemodialysis patients. The effect of rHuEpo is usually assessed by haematological indices such as red blood cell count, haemoglobin concentration and haematocrit, but erythrocyte indices do not provide information of the rapid change in erythropoietic activity. As erythrocyte creatine directly assess erythropoiesis, the aim of this study was to evaluate the effect of rHuEpo in haemodialysis patients by measuring erythrocyte creatine. Methods: rHuEpo dose was fixed 3 months prior to the enrollment and was maintained throughout the entire study period. Eerythrocyte creatine was measured with haematologic indices in 83 haemodialysis patients. Haemoglobin was also measured 3 months after. Results: rHuEpo dose (152.4±62.9 vs. 82.2±45.5 units/kg/week, P=0.0001) and erythrocyte creatine (2.07±0.73 vs. 1.60±0.41 µmol/gHb, p=0.0003) were significantly higher in 27 patients with haemoglobin <10g/dL compared to 56 patients with haemoglobin ≥10g/dL. There was a fair correlation between rHuEpo dose and erythrocyte creatine (r=0.55, P <0.0001). Increase in haemoglobin (>0.1g/dL) was observed in 37 patients, whereas haemoglobin did not increase in 46 patients. Erythrocyte creatine was significantly higher in patients with increase in haemoglobin compared to those without (2.04±0.64 vs. 1.52±0.39 µmol/gHb, p <0.0001). When 8 variables (rHuEpo dose, erythropoietin resistance index, C-reactive protein, intact parathyroid hormone, incidence of iron deficiency, presence of anaemia, erythrocyte creatine and reticulocyte) were used in the multivariate logistic analysis, erythrocyte creatine emerged as the most important variable associated with increase in haemoglobin (Chi-square=6.19, P=0.01). Conclusion: Erythrocyte creatine, a useful marker of erythropoietic capacity, is a reliable marker to estimate ameliorative effectiveness of rHuEpo in haemodialysis patients.

Relationships among the Dosage of Erythropoiesis-Stimulating Agents, Erythropoietin Resistance Index, and Mortality in Maintenance Hemodialysis Patients

2021 ◽  
pp. 1-11
Author(s):  
Sai Pan ◽  
De-Long Zhao ◽  
Ping Li ◽  
Xue-Feng Sun ◽  
Jian-Hui Zhou ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Resistance Index ◽  
Cox Proportional Hazards Model ◽  
Maintenance Hemodialysis ◽  
Erythropoiesis Stimulating Agents ◽  
All Cause Mortality ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

<b><i>Background:</i></b> Erythropoiesis-stimulating agents (ESAs) constitute an important treatment option for anemia in hemodialysis (HD) patients. We investigated the relationships among the dosage of ESA, erythropoietin resistance index (ERI) scores, and mortality in Chinese MHD patients. <b><i>Methods:</i></b> This multicenter observational retrospective study included MHD patients from 16 blood purification centers (<i>n</i> = 824) who underwent HD in 2011–2015 and were followed up until December 31, 2016. We collected demographic variables, HD parameters, laboratory values, and ESA dosages. Patients were grouped into quartiles according to ESA dosage to study the effect of ESA dosage on all-cause mortality. The ERI was calculated as follows: ESA (IU/week)/weight (kg)/hemoglobin levels (g/dL). We also compared outcomes among the patients stratified into quartiles according to ERI scores. We used the Cox proportional hazards model to measure the relationships between the ESA dosage, ERI scores, and all-cause mortality. Using propensity score matching, we compared mortality between groups according to ERI scores, classified as either &#x3e; or ≤12.80. <b><i>Results:</i></b> In total, 824 patients were enrolled in the study; 200 (24.3%) all-cause deaths occurred within the observation period. Kaplan-Meier analyses showed that patients administered high dosages of ESAs had significantly worse survival than those administered low dosages of ESAs. A multivariate Cox regression identified that high dosages of ESAs could significantly predict mortality (ESA dosage &#x3e;10,000.0 IU/week, HR = 1.59, 95% confidence intervals (CIs) (1.04, 2.42), and <i>p</i> = 0.031). Our analysis also indicated a significant increase in the risk of mortality in patients with high ERI scores. Propensity score matching-analyses confirmed that ERI &#x3e; 12.80 could significantly predict mortality (HR = 1.56, 95% CI [1.11, 2.18], and <i>p</i> = 0.010). <b><i>Conclusions:</i></b> Our data suggested that ESA dosages &#x3e;10,000.0 IU/week in the first 3 months constitute an independent predictor of all-cause mortality among Chinese MHD patients. A higher degree of resistance to ESA was related to a higher risk of all-cause mortality.

scholarly journals The Assessment of the Innovativeness of a New Medicine in Italy

2021 ◽  
Vol 8 ◽  
Author(s):  
Filomena Fortinguerra ◽  
Serena Perna ◽  
Roberto Marini ◽  
Alessandra Dell'Utri ◽  
Maurizio Trapanese ◽  
...  
Keyword(s):  
Decision Process ◽  
Classification Tree ◽  
Orphan Drugs ◽  
Important Variable ◽  
Medical Product ◽  
Chi Square ◽  
New Approach ◽  
Exact Test ◽  
Therapeutic Value

Objectives: Starting from April 2017, the Italian Medicine Agency (AIFA) has approved new criteria for defining any new medicinal product with an innovative indication. The purpose of the study is to analyze the activity of innovativeness evaluation according to the new approach, to estimate the weight of each criterion considered for innovativeness definition, and to evaluate how the new approach works in terms of consistency and reproducibility.Methods: A retrospective analysis was performed on the final reports evaluating the drug innovativeness assessment published on the AIFA's website between April 2017 and January 2021. Descriptive statistics, chi-square test, whether the conditions were respected, or Fisher's exact test was used to explore the association between characteristics of drugs and the innovativeness status and the association between the three criteria. Profiles of the decision process and their relationship with innovativeness response were described. In order to evaluate the weight of each criterion in predicting the innovativeness status, a Classification Tree (CT) algorithm was applied.Results: Overall, of the 109 published drugs reports, 37 (33.9%) were recognized as fully innovative, 29 (26.6%) were considered conditionally innovative, while for 43 (39.4%) reports innovativeness was not recognized. Considering the three criteria of the decision process, the added therapeutic value was the only criterion statistically associated with a drug's degree of innovation (p &lt; 0.001). The therapeutic need and the quality of clinical evidence were statistically associated (p = 0.008) even if only a mild association was observed. The added therapeutic value was the most important variable in predicting the innovativeness status according to the classification tree (CT) model applied, achieving an accuracy of 89.4%. No difference was found between orphans and non-orphan drugs or oncological and non-oncological drugs.Discussion: The added therapeutic value is the most important criterion of the multidimensional approach for the innovativeness status definition of a new medical product. A mild association was found between the therapeutic need and the quality of evidence. Overall, similar decision profiles bring the same evaluation of innovativeness status, indicating a good consistency and reproducibility between decisions.

13 THE RELATIONSHIP BETWEEN EARLIER POSTPARTUM CYCLICITY AND SUBSEQUENT REPRODUCTIVE PERFORMANCE IN DAIRY COWS: A FIELD TRIAL

2011 ◽  
Vol 23 (1) ◽  
pp. 113
Author(s):  
I. H. Kim ◽  
H. C. Lee ◽  
H. G. Kang
Keyword(s):  
Dairy Cows ◽  
Body Condition ◽  
Reproductive Performance ◽  
Body Condition Score ◽  
Post Partum ◽  
Management Program ◽  
Breeding Period ◽  
Chi Square ◽  
Logistic Analysis ◽  
The Relationship

Earlier postpartum cyclicity based on hormonal analysis was related to the subsequent fertility, although it has not been clarified under field conditions. This field study examined the relationship between the detection of corpus luteum (CL) at the first post partum month and subsequent reproductive performance in dairy cows. Holstein dairy cows underwent ultrasonography (Sonoace 600 with 7.5 MHz linear-array transducer; Medison Co. Ltd., Korea) at 30 (±7) days postpartum to determine the existence of CL in ovaries and then divided into 2 groups based on the existence of CL; the CL group (n = 156) or the non-CL group (n = 281). At the same time of ultrasonography, all cows were scored for body condition. Cows received the normal herd reproductive management program including oestrous detection or synchronization, or synchronization of ovulation in the breeding period. Pregnancy was determined per rectum 60 days after artificial insemination by both ultrasonography and palpation. Reproductive performance data were collected for a minimum of 210 days postpartum. Reproduction data between the CL and non-CL groups were evaluated by t-test, chi-square test, or logistic regression using an SAS program (Version 9.1: SAS Institute, Inc., Cary, NC, USA). The proportion of cows with CL in ovaries at 30 (±7) days postpartum was 35.7% of all cows. The number of days to first insemination after calving was more delayed (P < 0.0001) in the non-CL group (100.1 ± 2.7 days) than in the CL group (80.9 ± 2.9 days), while the pregnancy rate to first insemination did not differ (P > 0.05) between the CL group (44.2%) and the non-CL group (45.9%). The CL group had higher pregnancy proportions (PP) within 60 (odds ratio, OR = 2.3; P = 0.0063), 90 (OR = 1.6; P = 0.04), and 120 days (OR = 1.5; P = 0.05) postpartum than the non-CL group; however, the PP within 150 or 210 days postpartum did not differ between the 2 groups (P > 0.05). Besides, logistic analysis revealed that cows with body condition score (BCS) ≥3.00 were more likely to have CL (OR = 1.8; P = 0.015) compared with cows with BCS ≤ 2.75, while primiparous cows were less likely to have CL (OR = 0.6; P = 0.0085) compared with multiparous cows. In addition, cows that underwent ultrasonography later than 30 days postpartum were more likely to have CL (OR = 1.6; P = 0.0192) compared with cows that underwent ultrasonography earlier. In conclusion, the earlier cyclicity based on the detection of CL using ultrasonography at the first postpartum month, which might be in part due to a higher BCS, predicts an enhanced reproductive performance in dairy cows, particularly during the early and early-mid lactations. This work was supported by the research grant of the Chungbuk National University in 2010.

Erythropoietin Resistance Index and the All-Cause Mortality of Chronic Hemodialysis Patients

2014 ◽  
Vol 37 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Masayuki Okazaki ◽  
Mizuki Komatsu ◽  
Hiroshi Kawaguchi ◽  
Ken Tsuchiya ◽  
Kosaku Nitta
Keyword(s):  
Resistance Index ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
All Cause Mortality ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

Effects of Recombinant Human Erythropoietin in Infants with Very Low Birth Weights

1996 ◽  
Vol 24 (2) ◽  
pp. 190-198 ◽  
Author(s):  
N Samanci ◽  
F Ovali ◽  
T Da͂o͂lu
Keyword(s):  
Recombinant Human Erythropoietin ◽  
Day Treatment ◽  
Haemoglobin Concentration ◽  
The Third ◽  
Human Erythropoietin ◽  
Erythropoietin Production ◽  
End Of Treatment ◽  
Anaemia Of Prematurity ◽  
Oral Supplements ◽  
To Receive

Anaemia of prematurity, a postnatal fall in haemoglobin concentration and haematocrit, is particularly common in those born at less than 32 weeks of gestation. Experimental and clinical data implicate inadequate erythropoietin production as an important reason. In this study recombinant human erythropoietin (r-HuEpo) was used in an attempt to treat or prevent this anaemia and thereby provide an alternative to erythrocyte transfusions. Premature infants (birth weight ≤ 1250 g and gestational age ≤ 32 weeks), who were likely to need transfusions, were randomly assigned to receive 4 weeks of treatment with either subcutaneously administered r-HuEpo (200 U; n = 12) or placebo ( n = 12), three times weekly. All patients had oral supplements of elemental iron at a dose of 3 mg/kg/day. Treatment was started in the third week of life. Reticulocyte counts were significantly raised ( P < 0.05) in the group treated with r-HuEpo at the end of treatment. The neonates in the group treated with r-HuEpo needed fewer erythrocyte transfusions than those in the placebo group during treatment. There were no toxic effects attributable to r-HuEpo. The results indicate that treatment of infants with very low birth weights with r-HuEpo will reduce their need for erythrocyte transfusions

scholarly journals HUBUNGAN ASUPAN ZAT BESI, PROTEIN, VITAMIN C DAN POLA MENSTRUASI DENGAN KADAR HEMOGLOBIN PADA REMAJA PUTRI DI SMAN 1 MANYAR GRESIK[Correlation Between Intake of Iron, Protein, Vitamin C and Menstruation Pattern with Haemoglobin Concentration among Adolescent Girl in Senior High School 1 Manyar Gresik]

2019 ◽  
Vol 14 (2) ◽  
pp. 147
Author(s):  
Cynthia Almaratus Sholicha ◽  
Lailatul Muniroh
Keyword(s):  
Vitamin C ◽  
Adolescent Girls ◽  
Adolescent Girl ◽  
Haemoglobin Concentration ◽  
Growth Period ◽  
Chi Square ◽  
Cross Sectional ◽  
Iron Protein ◽  
Chi Square Test ◽  
Nutrition Problem

One of nutrition problem that needs to get high attention is anemia. Anemia is a condition that develops when healthy red blood cells below normal. Inadequate intake of nutrient, menstruation, infectious diseases, and lack of knowledge can caused anemia. Monthly menstruation and growth period drive adolescent girls pronen to anemia. The purpose of this study was to analyze correlation between intake of iron, protein, vitamin C and menstruation patterns with anemia among adolescent girls. This study used cross sectional design. Population of this study was adolescent student grade X and XI at SMAN 1 Manyar Gresik. Sixty two students were selected using proportional random sampling . Data were collected with semi quantitative food frequency questionnaire, structured questionnaire, and digital haemoglobinmeter. Data were analyzed using Spearman correlation test and Chi-square test. Results showed intake of iron (r=0.635; p=0.000), protein (r=0.663; p=0.000), and vitamin C (r=0.780; p=0.000) was correlated with haemoglobin concentration similiar with menstruation pattern which also had signifi cant correlation with anemia (p=0.002). Lower intake of iron, protein and vitamin C, caused lower haemoglobin concentration. Thus, anemia incidence will be higher. Adolescent girl are expected to increase food consumption of food source of iron and consume iron supplement routinely to replace iron that lost during menstruation.

scholarly journals What Are the Main Risk Factors for Lower Extremity Running-Related Injuries? A Retrospective Survey Based on 3669 Respondents

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110434
Author(s):  
Damien Sanfilippo ◽  
Charlotte Beaudart ◽  
Allan Gaillard ◽  
Stephen Bornheim ◽  
Olivier Bruyere ◽  
...  
Keyword(s):  
Risk Factors ◽  
Online Survey ◽  
Personal Characteristics ◽  
Chi Square ◽  
Level Of Evidence ◽  
Previous Injury ◽  
Logistic Analysis ◽  
Qualitative Variables ◽  
Relevant Risk Factor ◽  
Chi Square Test

Background: Despite the many studies on running-related injuries (RRIs), risk factors for injury remain unclear in the literature. Purpose: To investigate the risk factors of RRIs. Study Design: Case-control study; Level of evidence, 3. Methods: An online survey was conducted among 3669 injured and noninjured runners. Injury was defined as pain of various kinds, without attention to its consequences on running practice. The survey included 41 questions on 5 main categories—personal characteristics, daily lifestyle, training and running characteristics, practice of other sporting activities, and prevention habits—as well as information about the occurrence of RRI over the previous 12 months. Continuous and qualitative variables were analyzed by Student t test and chi-square test, respectively. Sixteen variables were selected for multivariate binary logistic analysis. Results: Among the 3669 runners, 1852 (50.5%) reported at least 1 injury over the previous 12 months. Overuse injuries were largely represented (60.6%). The variables associated with RRIs that remained significant in the fully adjusted model were previous injury (odds ratio [OR], 1.62; 95% CI, 1.42-1.86), higher weight (OR, 1.006; 95% CI, 1.00-1.012), competitive running (OR, 1.53; 95% CI, 1.19-1.98), running >2 h/wk (OR, 1.28; 95% CI, 1.01-1.62), running >20 km/wk (OR, 1.25; 95% CI, 1.001-1.55), and stretching before running (OR, 1.46; 95% CI, 1.25-1.71). Conclusion: Previous injury remains the most relevant risk factor for RRIs according to the current study and previous data. Many training characteristics seem to be involved but still have to be confirmed in view of conflicting data in the literature. Further research would help clinicians better understand RRIs and how to prevent them.

scholarly journals The attention of students during physical education class based on academic performance (La atención de los estudiantes durante la clase de educación física basada en el rendimiento académico)

Retos ◽  
2020 ◽  
pp. 222-228
Author(s):  
Jorge Manuel Folgado dos Santos ◽  
João Manuel Patricio Duarte Petrica ◽  
João Júlio Matos Serrano ◽  
Marco Alexandre da Silva Batista ◽  
Samuel Alexandre de Almeida Honório ◽  
...  
Keyword(s):  
Academic Performance ◽  
Physical Education ◽  
Basic Education ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Important Variable ◽  
Cognitive Resources ◽  
Physical Education Class ◽  
Chi Square ◽  
Education Class

Abstract. Attention is an important variable that can dictate the success and failure of an activity or task. This variable is characterized by the ability to direct cognitive resources to a given situation. The purpose of this research was to find patterns in the students' attention profiles, according to their academic achievement, during the physical education class and in different sports. We used the ATEST-EF questionnaire (Petrica, 2010) in which students had to answer the question "What were you thinking the moment you heard the signal?" The study involved 156 students from the 3th cycle of basic education, aged between 12 and 16 years old ( 16vó">  = 14,7 ± 1,3) evaluated in four different sports taught in the discipline of physical education (athletics, gymnastics, basketball and football), and in four moments of the class. Considering our variables, we used Chi-Square and Kruskal-Wallis statistical tests. The results show that task attendance holds the highest percentage values throughout the class in relation to the remaining categories, regardless of their academic performance and sport, but we observed that students with satisfactory and good academic performance have more stable values of attention regarding the students with less academic performance. We found statistical significance at the end of the class between students with good academic performance and affective attention, and among students with lower academic performance and attention to other things. Subsequently, we used the same classification to compare the profiles of attention among the four mentioned sports. We observed some patterns between team and individual sports, but did not find statistically differences, however the results suggest a positive relationship between attention and academic performance.Resúmen: La atención es una variable importante que puede dictar el éxito y el fracaso de una actividad o tarea. Esta variable se caracteriza por la capacidad de dirigir recursos cognitivos a una situación dada. El propósito de esta investigación fue encontrar patrones en los perfiles de atención de los estudiantes, de acuerdo con sus logros académicos, durante la clase de educación física y en diferentes deportes. Utilizamos el cuestionario ATEST-EF (Petrica, 2010) en el que los estudiantes tenían que responder la pregunta "¿Qué estaba pensando en el momento en que escuchó la señal?" En el estudio participaron 156 estudiantes del tercer ciclo de educación básica, con edades comprendidas entre 12 y 16 años (= 14,7 ± 1,3) evaluados en cuatro deportes diferentes que se imparten en la disciplina de educación física (atletismo, gimnasia, baloncesto y fútbol), y en cuatro momentos de la clase. Considerando nuestras variables, utilizamos las pruebas estadísticas Chi-Square y Kruskal-Wallis. Los resultados muestran que la asistencia a las tareas tiene los valores porcentuales más altos en toda la clase en relación con las categorías restantes, independientemente de su rendimiento académico y deporte, pero observamos que los estudiantes con un rendimiento académico satisfactorio y bueno tienen valores de atención más estables con respecto a los estudiantes con Menos rendimiento académico. Encontramos significación estadística al final de la clase entre estudiantes con buen rendimiento académico y atención afectiva, y entre estudiantes con bajo rendimiento académico y atención a otras cosas. Posteriormente, utilizamos la misma clasificación para comparar los perfiles de atención entre los cuatro deportes mencionados. Observamos algunos patrones entre el equipo y los deportes individuales, pero no encontramos diferencias estadísticas, sin embargo, los resultados sugieren una relación positiva entre la atención y el rendimiento académico.

scholarly journals Nutrition, anaemia and erythropoietin therapy

1999 ◽  
Vol 3 (2) ◽  
Author(s):  
Iain C. Macdougall
Keyword(s):  
Recombinant Human Erythropoietin ◽  
Ventricular Hypertrophy ◽  
Haemoglobin Concentration ◽  
Left Ventricular ◽  
Dialysis Patients ◽  
Renal Anaemia ◽  
Human Erythropoietin ◽  
Cardiovascular Morbidity And Mortality ◽  
Objective Evidence

During the last decade, recombinant human erythropoietin has revolutionised the management of renal anaemia. It is highly effective in the vast majority of patients treated, causing enhanced erythropoiesis and a rise in haemoglobin concentration. This has resulted not only in amelioration of uraernic symptoms, but there has also been objective evidence of improved quality-of-life, exercise capacity, and cardiac function [I]. The most striking benefits seen have been progression of left ventricular hypertrophy which is known to account for much of the high cardiovascular morbidity and mortality seen in dialysis patients. and thus the arguments for correcting renal anaemia is now overwhelming. There is also an improvement in nutrition following erythropoietin therapy, over and above the improvement in appetite associated with correction of the anaemia.

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