Nephrol Dial Transplant (1998) 13 [Suppl 2]: 3–8 Nephrology Dialysis

Abstract The need for a renewable source of erythro- relation to the evolution of renal replacement treat-ment. Haemodialysis for end-stage renal failurepoietin to treat the anaemia of chronic renal failure was first recognized in the 1960s, but cloning and (ESRF) was first described in 1960 but r-HuEPO only became available 28 years later (Figure 1). The needexpression of the human gene was not achieved until 1983. Clinical testing of recombinant human erythro- was predicted by Hegstrom et al. in their paper entitled ‘Haemodialysis in the treatment of chronic uraemia’,poietin (r-HuEPO) began in 1985, leading to the first licence as a therapeutic agent in 1988. The first clinical published in the transactions of American Society for Artificial Internal Organs in 1961, in which they wrotetrials showed that an intravenous dose requirement of about 200 IU/kg/week would increase haemoglobin with remarkable prescience, ‘Supplementary erythro-poietin, were it available, might reduce significantlyconcentrations to 10–12 g/dl in>90 % of haemodi-alysis patients. Subcutaneous administration has sub- the transfusion requirements ’ [1]. The management of anaemia before the availabilitysequently been found to be eVective, and may allow lower maintenance doses. It is now the route of choice of r-HuEPO was a struggle. Faith was put in ‘good dialysis’, minimizing blood loss, avoiding nephrectomy,in Europe, but not the USA. The best marker of benefit of the introduction of r-HuEPO is the reduction administering parenteral iron, pharmacological dose