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Anemia(hematocrit<25%)predictably accompanies chronic renal failure and is present in over 90%of patients on chronic dialysis.Relative erythropoietin deficiency is the proximate cause.Recombinant human erythropoietin recently became available for research and clinical use.Erythropoietin production is regulated by a single copy gene located on chromosome 7;its expression has been shown in the kidney,liver,and macrophages.It is a glycosylated protein of 166 amino acids with a molecular weight of 34,000 D.When given to patients with the anemia of renal failure,erythropoietin causes a dose-dependent rise in hematocrit to the normal range within 8 to 14 weeks.Complications of this response are minimal except for a significant incidence of hypertension.When the anemia is corrected,the patient's quality of life,cognitive function,and brain electrophysiology improve dramatically.Recombinant human erythropoietin represents a major breakthrough in the treatment of patients with chronic renal failure. Current reimbursement constraints limit its full application. |
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