Anemia of chronic kidney disease is more prevalent at GFR <60 ml/min as a consequence of loss of erythropoietin synthesis by the kidney. Target goals for treatment are hemoglobin levels of 12 g/dL for males and 11 g/dL for females. One randomized controlled trial in patients with chronic kidney disease without dialysis comparing erythropoietin treatment vs. placebo reported significant improvement in energy levels and work capacity in the treatment group. Iron supplementation is necessary for effective erythropoiesis; when there is inadequate response to rHu-EPO, folate and vitamin B-12 status should also be evaluated. There are limited long term studies of the benefits of rHu-EPO in chronic kidney disease (non-dialysis).
