Treatment of renal anemia with recombinant human erythropoietin.

It has been 6 years since the first reports of the use of recombinant human erythropoietin for the treatment of renal anemia appeared in the medical literature. During this period, erythropoietin has become established as a safe and highly effective therapy, and it is currently being evaluated for other nonrenal types of anemia. The initial clinical trials were in hemodialysis patients, followed by patients receiving continuous ambulatory peritoneal dialysis, and its use in predialysis and renal transplant patients is increasing. Various treatment schedules have been tried and compared; there are now reports of dosage frequencies varying from once daily to once weekly. Information has accumulated on the secondary effects of correction of renal anemia, particularly in relation to quality of life, exercise capacity, and cardiac function. Large multicenter trials have documented the safety profile of erythropoietin, whereas smaller studies have sought to elucidate the pathophysiology of its side effects, eg, hypertension and thrombotic events. This article reviews the latest developments in the use of erythropoietin in renal failure, concentrating particularly on those that have been published within the past year. Although there have been exciting advances in our understanding of the physiology and molecular biology of erythropoietin, these are amply described elsewhere and are beyond the scope of the present review.