Erythropoietin and renal failure.
Erythropoietic therapy has transformed the management of the anemia associated with chronic renal failure over the past decade. The first agents that proved effective in stimulating erythropoiesis were the epoetins (alfa and beta), which are recombinant human erythropoietins (EPOs). The EPO molecule was recently modified using site-directed mutagenesis to produce darbepoetin alfa with a longer circulating half-life in vivo. The development of epoetin-induced pure red cell aplasia associated with anti-EPO antibodies shook the nephrology community last year, and gradually new information is emerging on the cause of this rare but important condition. Pure red cell aplasia has provoked new discussions on the best route (intravenously or subcutaneously) for administering erythropoietic therapy. Further research has been published regarding some of the more traditional, although still hotly debated, issues concerning renal anemia management, such as target hemoglobin, factors affecting the response to EPO, and adjuvant therapy to EPO. This review addresses these topics and focuses largely on the publications relevant to these areas of clinical anemia management.