### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi Doctor, My Mother is suffering from the CKD with severe Anaemia . Below ia the details Age: 63 Years DM: Since 2007 High BP: Since 2002 First CKD Diagnosed: Dec 2008 S. Creatinine: 2.6 Urea: 52 Haemoglobin: 4.3 After the Cataract operation on Jan 2012, Her health is down day by day. From March 2012, we used to do the blood transfusion of 2-3 unit once in 20-25 days. She is on complete diet as suggested by the dietician. Present Complaints: 1) Severe Weakness in whole body due to the Low HB count. we already had Erythroprotien inj like Vintor 0000unit, Cresp 2.5 mcv, & Eprex 4000 unit for monthy doses but no result. 2) Insomania( Not able to sleep at night), Although she is taking the Amlovas for the same. 3) Blowing sound on ear. 4) Heart beat increases continuosly throughout the day. Medication: Cudo Forte 0-0-1 Sobeasis Forte - 0-0-1 Glucobay- after meal 0-1-0 Nuroday : 1-0-0 Folvite: 0-0-1 Renal Resource Powder Sir, Please suggest us the solution for improving her HB level, so that other things will also improve simultaneoulsy. Many Thanks Shiva 0000

### output:

Hi Shiva. Thanks for the detailed history. Make my life much better when I get a good summary of the problems and list of medications! People with advanced CKD have deficiency of production of erythropoietin (EPO) and hence need it as injections. That along with replacement of any deficiency of the following - iron, Vitamin B12 and folate should be sufficient. Your mother has something more than simple EPO deficiency. Kindly consult a hematologist ASAP. She will need more tests and a Bone Marrow exam (if not already done) to diagnose the cause of severe anemia. Best wishes.