P. Biggar

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In July 2011, following many and especially the CANEPO, CREATE, CHOIR and TREAT studies the United States Food and Drug Administration significantly reduced hemoglobin target levels of patients receiving erythropoiesis stimulating agents. At the time of writing, KDIGO (Kidney Disease: Improving Global Outcomes working group) have also signalized similar precautionary recommendations. However, although the studies have demonstrated significant health risks involved in increasing hemoglobin levels unreflectedly, erythropoietin and erythropoiesis stimulating agents have a physiological function which is disturbed in kidney disease. Ameliorating these disturbances with the aim of restoring normal conditions and, thus, improving the wellbeing and prognosis of the patients who entrust their lives to us remains our obligation. Although the regulatory decisions are unprecedented, the studies have laid the basis for further research. It is the author’s belief that the future holds therapeutic combinations finally enabling us to achieve our goals.