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09-07-2024 | Erythropoietin | Nephrology – Review

Renal anemia: from relative insufficiency of EPO to imbalance of erythropoiesis and eryptosis

Authors: Mengxue Yuan, Xinping Chen, Ruilin Ou, Ruiling Luo, Wenwen Fan, Xiangming Wang, Zhentao Guo

Published in: International Urology and Nephrology

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Abstract

Chronic kidney disease has emerged as a major health issue both in China and worldwide. Renal anemia frequently occurs in patients with chronic kidney disease, and its severity and incidence rate increase as the disease progresses. Over the last 30 years, the administration of exogenous EPO and EPO stimulants has been employed to alleviate renal anemia, suggesting that a relative deficiency in EPO may be a primary cause. However, this approach has overshadowed other contributing factors, particularly eryptosis, which results from the reduced lifespan of red blood cells. Numerous studies reveal that there are nephrogenic and extrarenal EPO secretion indicating that an absolute deficiency of EPO is not always present in patients. Therefore, this paper speculates that renal anemia may arise when EPO-driven erythropoiesis fails to adequately compensate for aggravating eryptosis. Other factors including iron metabolism disorder, uremic toxin accumulation, inflammatory state, oxidative stress, and secondary hyperparathyroidism affect EPO reactivity bone marrow hematopoiesis and eryptosis, leading to an imbalance between red blood cell production and destruction, and cause anemia ultimately. More further studies on the pathogenesis and treatment of renal anemia would be expected to provide evidence to support our opinion.
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Metadata
Title
Renal anemia: from relative insufficiency of EPO to imbalance of erythropoiesis and eryptosis
Authors
Mengxue Yuan
Xinping Chen
Ruilin Ou
Ruiling Luo
Wenwen Fan
Xiangming Wang
Zhentao Guo
Publication date
09-07-2024
Publisher
Springer Netherlands
Published in
International Urology and Nephrology
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-024-04146-x
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