<s>[INST] hello doctor .my father aged 64 had diabetes and CKD...he was on dialysis before in goa...i brought him to bangalore in manipal..his creatinine is 3.6 doctors told us he does not need dialysis..he is on medication and he is advised inj espogen twice weekly..why doctor? [/INST] Most of the CKD patients are anemic because of many reasons like decreased life span of RBC, iron deficiency, b12 / folate deficiency and also due to erythropoietin deficiency(hormone secreted by well functioning kidney). Supplementing erythropoietin is useful in correcting anemia when all other factors are taken care of.... So there is no harm in taking spoken twice-weekly but make sure she doesn't have iron Deficiency ...and his BP at the time of injection should be less than 150/90...since it causes hypertension supplement other elements with Cap. Nephrofe /Tab. Folvite 5 mg. </s>