Recombinant human erythropoietin (rHuEPO) has revolutionized the treatment of anemia of chronic renal failure. RHuEPO has been shown to increase survival, decrease hospitalizations, improve brain and cognitive function, and improve quality of life for renal patients. Much has been learned about the normal and pathologic physiology of anemia because rHuEPO has become available to investigators, and this has been widely applied. Additional work is needed in better defining the sites of production of endogenous EPO as well as the nature and control of the oxygen sensor(s) in the kidney. Remaining clinical issues related to this remarkable compound include predicting and overcoming resistance; avoiding iron deficiency; determining the appropriate target hemoglobin; increasing the use strategies such as subcutaneous administration to increase efficiency; and devising a more rational payment scheme.
Copyright 2001 by W.B. Saunders Company.