Erythropoietin (EPO) - Function & Erythropoietin Therapy Side Effects (2023)


  • What is erythropoietin
    • Where is erythropoietin made?
      • Kidneys
    • Erythropoietin test
      • When is erythropoietin test ordered?
      • Erythropoietin level
    • Erythropoietin deficiency
    • Erythropoietin therapy
      • How should erythropoietin injection be used?
        • What special precautions should I follow?
        • What special dietary instructions should I follow?
        • What should I do if I forget a dose?
    • Erythropoietin side effects

Erythropoietin (EPO) is a hormone produced primarily by the healthy kidneys and a small amount in your liver 1. Erythropoietin prompts your bone marrowstem cells to makemore red blood cells, which then carry oxygen from the lungs to the rest of your body. When kidneys are diseased or damaged, they do not make enough erythropoietin. As a result, the bone marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it deprives the body of the oxygen it needs.

Erythropoietin is produced and released into the blood by the kidneys in response to low blood oxygen levels (hypoxemia). Erythropoietin (EPO) is carried to the bone marrow, where it stimulates production of red blood cells. The hormone is active for a short period of time and then eliminated from the body in the urine.

The amount of erythropoietin released depends upon how low the oxygen level is and the ability of the kidneys to produce erythropoietin. Increased production and release of erythropoietin continues to occur until oxygen levels in the blood rise to normal or near normal concentrations, then production falls. The body uses this dynamic feedback system to help maintain sufficient oxygen levels and a relatively stable number of red blood cells in the blood.

However, if a person’s kidneys are damaged and do not produce sufficient erythropoietin, then too few red blood cells are produced and the person typically becomes anemic. Similarly, if a person’s bone marrow is unable to respond to the stimulation from erythropoietin, then the person may become anemic. This can occur with some bone marrow disorders or with chronic diseases, such as rheumatoid arthritis.

Individuals who have conditions that affect the amount of oxygen they breathe in, such as lung diseases, may produce more erythropoietin to try to compensate for the low oxygen level. People who live at high altitudes may also have higher levels of erythropoietin and so do chronic tobacco smokers.

If too much erythropoietin is produced, as occurs with some benign or malignant kidney tumors and with a variety of other cancers, too many red blood cells may be produced (polycythemia or erythrocytosis). This can lead to an increase in the blood’s thickness (viscosity) and sometimes to high blood pressure (hypertension), blood clots (thrombosis), heart attack, or stroke. Rarely, polycythemia is caused by a bone marrow disorder called polycythemia vera, not by increased erythropoietin.

Where is erythropoietin made?

Many researchers have made rigorous efforts to identify erythropoietin-producing cells in kidneys; however, a uniform understanding of which cells produce erythropoietin in kidneys was not established until the era of genetically modified mice 2. Using gene targeting and bacterial artificial chromosome transgenic methods, scientists have identified nearly all of interstitial fibroblast-like cells in the cortex and outer medulla to be renal erythropoietin-producing cells (kidney erythropoietin-producing cells) 3. Furthermore, interests in renal erythropoietin-producing cells (kidney erythropoietin-producing cells) have markedly increased by the evidence showing the crucial link between fibrosis and anemia via the loss of erythropoietin-producing ability of myofibroblast-transformed renal erythropoietin-producing cells 4. Importantly, this direct link indicates that kidney fibrosis (scarring) and anemia could be simultaneously treated by targeting or regulating the cellular properties of renal erythropoietin-producing cells.


The paired kidneys are reddish, kidney bean–shaped organs located just above the waist between the peritoneum and the posterior wall of the abdomen. Because their position is posterior to the peritoneum of the abdominal cavity, the organs are said to be retroperitoneal (Figure 1). The kidneys are located between the levels of the last thoracicvertebrae T12 and third lumbar (L3) vertebrae, a position where they are partially protected by ribs 11 and 12. If these lower ribs are fractured, they can puncture the kidneys and cause significant, even life-threatening damage. The right kidney is slightly lower than the left (see Figure 1) because the liver occupies considerable space on the right side superior to the kidney.

A typical adult kidney is 10–12 cm (4–5 in.) long, 5–7 cm (2–3 in.) wide, and 3 cm (1 in.) thick—about the size of a bar of bath soap—and weighs about 135–150 g (4.5–5 oz). The concave medial border of each kidney faces the vertebral column. Near the center of the concave border is an indentation called the renal hilum, through which the ureter emerges from the kidney along with blood vessels, lymphatic vessels, and nerves.

Three layers of tissue surround each kidney. The deep layer, the renal capsule, is a smooth, transparent sheet of dense irregular connective tissue that is continuous with the outer coat of the ureter. It serves as a barrier against trauma and helps maintain the shape of the kidney. The middle layer, the adipose capsule, is a mass of fatty tissue surrounding the renal capsule. It also protects the kidney from trauma and holds it firmly in place within the abdominal cavity. The superficial layer, the renal fascia, is another thin layer of dense irregular connective tissue that anchors the kidney to the surrounding structures and to the abdominal wall. On the anterior surface of the kidneys, the renal fascia is deep to the peritoneum.

Figure 1. Kidney location

Erythropoietin (EPO) - Function & Erythropoietin Therapy Side Effects (1)

(Video) Erythropoietin (EPO)

Figure 2. Kidney anatomy

Erythropoietin (EPO) - Function & Erythropoietin Therapy Side Effects (2)

Figure 3. Kidney structure

Erythropoietin (EPO) - Function & Erythropoietin Therapy Side Effects (3)

Figure 4. Bone marrow anatomy

Erythropoietin (EPO) - Function & Erythropoietin Therapy Side Effects (4)

Figure 5. Red blood cell formation

Erythropoietin (EPO) - Function & Erythropoietin Therapy Side Effects (5)

Note: Low blood oxygen causes the kidneys and to a lesser degree, the liver to release erythropoietin. Erythropoietin stimulates target cells in the red bone marrow to increase the production of red blood cells, which carry oxygen to tissues.

Erythropoietin test

The erythropoietin test measures the amount of a hormone called erythropoietin (EPO) in blood. To do theerythropoietin test, a blood sample is obtained by inserting a needle into a vein in your arm. An erythropoietin test is used primarily to help diagnose the cause of anemia. It can help identify candidates for erythropoietin replacement therapy (e.g., people with chronic kidney disease). Sometimes erythropoietin test is used to help diagnose the cause of too many red blood cells (polycythemia or erythrocytosis) or as part of an evaluation of a bone marrow disorder.

An erythropoietin test is usually ordered in follow up to abnormal findings on a complete blood count (CBC), such as a low red blood cell (RBC) count and low hemoglobin and hematocrit. These tests establish the presence and severity of anemia and give the healthcare practitioner clues as to the likely cause of the anemia. Erythropoietin testing is ordered to help determine if low erythropoietin may be causing and/or worsening the anemia.

In people with chronic kidney disease, the test may be ordered to evaluate the kidneys’ continued ability to produce sufficient erythropoietin. If the erythropoietin level is low, erythropoietin replacement therapy may help increase red cell production in the bone marrow.

Occasionally, an erythropoietin test may be ordered in follow up to complete blood count (CBC) results that show an increased number of red blood cells, to help determine whether the excess production of red blood cells (polycythemia or erythrocytosis) is due to an overproduction of erythropoietin or some other cause (e.g., JAK2 mutation).

When is erythropoietin test ordered?

An erythropoietin test may be ordered when a person has anemia that does not appear to be caused by iron deficiency, vitamin B12 or folate deficiency, decreased lifespan of red blood cells (hemolysis), or by excessive bleeding. It may be ordered when the red blood cell count, hemoglobin, and hematocrit are decreased and the reticulocyte count is inappropriately normal or decreased.

(Video) RBCs& Erythropoietin (EPO)

If someone has chronic kidney disease, erythropoietin levels may be ordered when the healthcare practitioner suspects that kidney dysfunction could be associated with a decrease in erythropoietin production.

An erythropoietin test may be ordered when a complete blood count reveals that a person has an increased number of red blood cells and a high hematocrit and hemoglobin.

An erythropoietin test may be ordered when a healthcare practitioner suspects that a person has a bone marrow disorder, such as a myeloproliferative neoplasms or myelodysplastic syndrome.

Erythropoietin level

The normal erythropoietin range is 2.6 to 18.5 milliunits per milliliter (mU/mL). Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your health care provider about the meaning of your specific test result.

Increased erythropoietin level may be due to secondary polycythemia. This is an overproduction of red blood cells that occurs in response to an event such as low blood oxygen level. The condition may occur at high altitudes or, rarely, because of a tumor that releases erythropoietin.

Lower-than-normal erythropoietin level may be seen in chronic kidney failure, anemia of chronic disease, or polycythemia vera.

  • If a person is anemic and erythropoietin levels are low or normal, then the kidneys may not be producing an appropriate amount of the hormone.
  • If a person is anemic and erythropoietin levels are increased, then the anemia may be due to iron or vitamin deficiency, or a bone marrow disorder.
  • If a person has too many red blood cells and erythropoietin levels are increased, then it is likely that excess erythropoietin is being produced – either by the kidneys or by other tissues in the body. This condition is called secondary polycythemia.
  • If there is excess red blood cell production and erythropoietin levels are normal or low, then it is likely that the polycythemia has a cause that is independent of erythropoietin production. This condition is called primary polycythemia.

Table 1. What abnormal erythropoietin results mean

Erythropoietin levelExample(s) of possible cause(s)Condition present
Low or normalSevere kidney diseaseAnemia (low red blood cells, hemoglobin and hematocrit)
HighBone marrow disorder (e.g., myelodysplastic syndrome)Anemia
HighErythropoietin-producing kidney tumor or other tissue (secondary polycythemia)Polycythemia (high red blood cells, hemoglobin and hematocrit)
Normal or lowPolycythemia vera (primary polycythemia)Polycythemia

Erythropoietin deficiency

Erythropoietin an essential hormone for red blood cell production, is mainly produced in the liver before birth and in the kidney after birth 5. Erythropoietin is regulated in an oxygen-dependent manner by hypoxia inducible factor 6. Under hypoxic conditions, hypoxia inducible factor proteins become stable and upregulate downstream genes including erythropoietin. The kidney is a hypoxic organ because of huge oxygen consumption for tubular reabsorption 7. The physiological hypoxia makes the kidney an appropriate organ for sensitively detecting oxygen levels and producing erythropoietin.

Erythropoietin-deficiency anemia occurs in chronic kidney disease patients and in preterm neonates. In chronic kidney disease, renal anemia occurs since erythropoietin-producing fibroblasts transdifferentiate into myofibroblasts in response to injuries 5.

Erythropoietin therapy

Erythropoietin(EPO) alfa injection is used to treat anemia (a lower than normal number of red blood cells) in people with chronic kidney failure (condition in which the kidneys slowly and permanently stop working over a period of time). Erythropoietin alfa injection is also used to treat anemia caused by chemotherapy in people with certain types of cancer or caused by zidovudine (AZT, Retrovir, in Trizivir, in Combivir), a medication used to treat human immunodeficiency virus (HIV). Erythropoietin alfa injection is also used before and after certain types of surgery to decrease the chance that blood transfusions (transfer of one person’s blood to another person’s body) will be needed because of blood loss during surgery. Erythropoietin alfa injection should not be used to decrease the risk that transfusions will be needed in people who are having surgery on their hearts or blood vessels. Erythropoietin alfa injection also should not be used to treat people who are able and willing to donate blood before surgery so that this blood can be replaced in their bodies during or after surgery. Erythropoietin alfa injection cannot be used in place of a red blood cell transfusion to treat severe anemia and has not been shown to improve tiredness or poor well-being that may be caused by anemia. Erythropoietin alfa is in a class of medications called erythropoiesis-stimulating agents (ESAs). It works by causing the bone marrow (soft tissue inside the bones where blood is made) to make more red blood cells.

Erythropoietin (EPO) is a very large protein and does not cross the dialysis membrane during dialysis. Erythropoietin can be given either as an injection underneath the skin (subcutaneous) which results in a more sustained and longer action for the drug in the body. Erythropoietin can also be given intravenously through the tubes or lines on the dialysis machine. Erythropoietin can be given in the venous line as one is coming off of dialysis or it can be given at any time during dialysis as long as it is given in the venous line. In the dialysis unit, it is commonly given sometime in the last 30 minutes of the dialysis treatment or with the rinse back of the patient. Both of these techniques work equally well, but the drug has a shorter duration of action than giving it subcutaneously.

Erythropoietin Therapy Warning

ALL patients

Using erythropoietin alfa injection increases the risk that blood clots will form in or move to the legs, lungs, or brain. Tell your doctor if you have or have ever had heart disease and if you have ever had a stroke. Call your doctor immediately or get emergency medical help if you experience any of the following symptoms: pain, tenderness, redness, warmth, and/or swelling in the legs; coolness or paleness in an arm or leg; shortness of breath; cough that won’t go away or that brings up blood; chest pain; sudden trouble speaking or understanding speech; sudden confusion; sudden weakness or numbness of an arm or leg (especially on one side of the body) or of the face; sudden trouble walking, dizziness, or loss of balance or coordination; or fainting. If you are being treated with hemodialysis (treatment to remove waste from the blood when the kidneys are not working), a blood clot may form in your vascular access (place where the hemodialysis tubing connects to your body). Tell your doctor if your vascular access is not working as usual.

Your doctor will adjust your dose of epoetin alfa injection so that your hemoglobin level (amount of a protein found in red blood cells) is just high enough that you do not need a red blood cell transfusion (transfer of one person’s red blood cells to another person’s body to treat severe anemia). If you receive enough epoetin alfa to increase your hemoglobin to a normal or near normal level, there is a greater risk that you will have a stroke or develop serious or life threatening heart problems including heart attack or heart failure. Call your doctor immediately or get emergency medical help if you experience any of the following symptoms: chest pain, squeezing pressure, or tightness; shortness of breath; nausea, lightheadedness, sweating, and other early signs of heart attack; discomfort or pain in the arms, shoulder, neck, jaw, or back; or swelling of the hands, feet, or ankles.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body’s response to epoetin alfa injection. Your doctor may decrease your dose or tell you to stop using epoetin alfa injection for a period of time if the tests show that you are at high risk of experiencing serious side effects of epoetin alfa injection. Follow your doctor’s directions carefully.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with erythropoietin alfa injection and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions.

Talk to your doctor about the risks of using erythropoietin alfa injection.

CANCER patients

In clinical studies, people with certain cancers who received erythropoietin alfa injection died sooner or experienced tumor growth, a return of their cancer, or cancer that spread sooner than people who did not receive the medication. If you have cancer, you should receive the lowest possible dose of erythropoietin alfa injection. You should only receive erythropoietin alfa injection to treat anemia caused by chemotherapy if your chemotherapy is expected to continue for at least 2 months after you start your treatment with erythropoietin alfa injection and if there is not a high chance that your cancer will be cured. Treatment with erythropoietin alfa injection should be stopped when your course of chemotherapy ends.

A program called the ESA APPRISE Oncology Program has been set up to decrease the risks of using erythropoietin alfa injection to treat anemia caused by chemotherapy. Your doctor will need to complete training and enroll in this program before you can receive erythropoietin alfa injection. As part of the program, you will receive written information about the risks of using erythropoietin alfa injection and you will need to sign a form before you receive the medication to show that your doctor has discussed the risks of erythropoietin alfa injection with you. Your doctor will give you more information about the program and will answer any questions you have about the program and your treatment with erythropoietin alfa injection.

SURGICAL patients

You may be given erythropoietin alfa injection to decrease the risk that you will develop anemia and require a blood transfusion as a result of blood loss during surgery. However, receiving erythropoietin alfa injection before and after surgery may increase the risk that you will develop a dangerous blood clot during or after surgery. Your doctor will probably prescribe medication to help prevent blood clots.


How should erythropoietin injection be used?

Erythropoietin injection comes as a solution (liquid) to inject subcutaneously (just under the skin) or intravenously (into a vein). It is usually injected one to three times weekly. When erythropoietin alfa injection is used to decrease the risk that blood transfusions will be required due to surgery, it is sometimes injected once daily for 10 days before surgery, on the day of surgery and for 4 days after surgery. Alternatively, erythropoietin alfa injection is sometimes injected once weekly, beginning 3 weeks before surgery and on the day of surgery. To help you remember to use erythropoietin alfa injection, mark a calendar to keep track of when you are to receive a dose. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use erythropoietin alfa injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Your doctor will start you on a low dose of erythropoietin alfa injection and adjust your dose depending on your lab results and how you are feeling, usually not more than once every month. Your doctor may also tell you to stop using erythropoietin injection for a time. Follow these instructions carefully.

erythropoietin injection will help control your anemia only as long as you continue to use it. It may take 2–6 weeks or longer before you feel the full benefit of erythropoietin injection. Do not stop using erythropoietin injection without talking to your doctor.

(Video) Erythropoietin (EPO) in response to anemia

erythropoietin injections may be given by a doctor or nurse, or your doctor may decide that you can inject erythropoietin yourself or that you may have a friend or relative give the injections.You and the person who will be giving the injections should read the manufacturer’s information for the patient that comes with erythropoietin injection before you use it for the first time at home. Ask your doctor to show you or the person who will be injecting the medication how to inject it.

If you are using erythropoietin injection at home, you will need to use disposable syringes and needles to inject your medication. Your doctor or pharmacist will tell you what type of syringe you should use. Do not use any other type of syringe because you may not get the right amount of medication. Always keep a spare syringe and needle on hand.

Erythropoietin injection comes in multidose vials and single use vials. The multidose vials contain benzyl alcohol, a preservative that may be harmful to babies, so erythropoietin injection from multidose vials cannot be used to treat pregnant or nursing women or babies. The single use vials do not contain benzyl alcohol and may be used to treat pregnant or nursing women or babies, but they are only safe to use one time. Do not put a needle through the rubber stopper of the single use vial more than once. Dispose of the single use vial after you have used it for one dose, even if it is not empty.

Do not shake erythropoietin injection. If you shake the medication, it may look foamy and should not be used.

Always inject erythropoietin in its own syringe; never mix it with any other medication.

You can inject erythropoietin just under the skin anywhere on the outer area of your upper arms, middle of the front thighs, stomach (except for a 2-inch [5 centimeter] area around the navel [belly button]), or outer area of the buttocks. Do not inject erythropoietin into a spot that is tender, red, bruised, hard, or has scars or stretch marks. Choose a new spot each time you inject erythropoietin, as directed by your doctor. Write down the date, time, dose of erythropoietin injection, and the spot where you injected your dose in a record book.

If you are being treated with dialysis (treatment to remove waste from the blood when the kidneys are not working), your doctor may tell you to inject the medication into your venous access port. Ask your doctor if you have any questions about how to inject your medication.

Always look at erythropoietin solution before you inject it. Be sure that the vial is labeled with the correct name and strength of medication and an expiration date that has not passed. Also check that the solution is clear and colorless and does not contain lumps, flakes, or particles. If there are any problems with your medication, call your pharmacist and do not inject it.

Do not use disposable syringes more than once. Dispose of used syringes in a puncture-resistant container. Ask your doctor or pharmacist how to dispose of the puncture-resistant container.

This medication may be prescribed for other uses. Talk to your doctor about the risks of using this medication for your condition.

What special precautions should I follow?

Before using erythropoietin injection:

  • tell your doctor and pharmacist if you are allergic to erythropoietin, darberythropoietin (Aranesp), any other medications, or any of the ingredients in erythropoietin injection. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have had high blood pressure and if you have ever had pure red cell aplasia (a type of severe anemia that may develop after treatment with an erythropoiesis-stimulating agent such as darberythropoietin injection or erythropoietin injection). Your doctor may tell you not to use erythropoietin injection.
  • tell your doctor if you have or have ever had seizures. If you are using erythropoietin injection to treat anemia caused by chronic kidney disease, tell your doctor if you have or have ever had cancer.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using erythropoietin injection, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using erythropoietin injection.

What special dietary instructions should I follow?

Your doctor may prescribe a special diet to help control your blood pressure and to help increase your iron levels so that erythropoietin injection can work as well as possible. Follow these directions carefully and ask your doctor or dietician if you have any questions.

What should I do if I forget a dose?

Call your doctor to ask what to do if you miss a dose of erythropoietin injection. Do not use a double dose to make up for a missed one.

Erythropoietin side effects

Erythropoietin injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

(Video) EPO stands for eythropoietin.

  • headache
  • joint or muscle aches, pain, or soreness
  • nausea
  • vomiting
  • indigestion
  • weight loss
  • sores in the mouth
  • difficulty falling asleep or staying asleep
  • depression
  • redness, swelling, pain, or itching at the injection spot

Some side effects can be serious. If you experience any of the following symptoms, or those listed in the Erythropoietin Therapy Warning section, call your doctor immediately or get emergency medical treatment:

  • rash
  • hives
  • itching
  • swelling of the face, throat, tongue, lips, or eyes
  • wheezing
  • difficulty breathing or swallowing
  • hoarseness
  • lack of energy
  • dizziness
  • fainting

Erythropoietin injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication.


  1. Souma T, Suzuki N, Yamamoto M. Renal erythropoietin-producing cells in health and disease. Frontiers in Physiology. 2015;6:167. doi:10.3389/fphys.2015.00167.
  2. Use of gene-manipulated mice in the study of erythropoietin gene expression. Suzuki N, Obara N, Yamamoto M. Methods Enzymol. 2007; 435():157-77.
  3. A mouse model of adult-onset anaemia due to erythropoietin deficiency. Yamazaki S, Souma T, Hirano I, Pan X, Minegishi N, Suzuki N, Yamamoto M. Nat Commun. 2013; 4:1950.
  4. Plasticity of renal erythropoietin-producing cells governs fibrosis. Souma T, Yamazaki S, Moriguchi T, Suzuki N, Hirano I, Pan X, Minegishi N, Abe M, Kiyomoto H, Ito S, Yamamoto M. J Am Soc Nephrol. 2013 Oct; 24(10):1599-616.
  5. Souma T, Suzuki N, Yamamoto M. Renal erythropoietin-producing cells in health and disease. Frontiers in physiology. 2015;6:167. doi: 10.3389/fphys.2015.00167
  6. Souma T, Suzuki N, Yamamoto M. Renal erythropoietin-producing cells in health and disease. Frontiers in physiology. 2015;6:167. doi: 10.3389/fphys.2015.00167.
  7. Evans RG, Gardiner BS, Smith DW, O’Connor PM. Intrarenal oxygenation: unique challenges and the biophysical basis of homeostasis. American journal of physiology. Renal physiology. 2008;295:F1259–1270. doi: 10.1152/ajprenal.90230.2008


What are the major effects of erythropoietin? ›

Erythropoietin (Epo), which is produced by the kidney in the adult and by the liver in the fetus, increases red blood cells by supporting the survival of erythroid progenitor cells and stimulating their differentiation and proliferation via binding to Epo receptor (EpoR).

Does EPO improve kidney function? ›

Erythropoietin helps people with kidney failure and symptoms from anaemia who are not yet on dialysis. Anaemia (low red blood cells) is a common complication of kidney failure.

What are the long term effects of EPO? ›

If EPO levels are too high the body will produce too many red blood cells which can thicken the blood, leading to clotting, heart attack and stroke. Repeated doses of EPO can also stimulate the development of antibodies directed against EPO, which can result in anaemia.

Which is most likely a side effect of erythropoietin? ›

Erythropoietin may cause high blood pressure. Tell your doctor or nurse if you have ever had any problems with your blood pressure. You should also tell them if you take any medication for high blood pressure.

Is EPO a side effect of kidney disease? ›

When you have kidney disease, your kidneys cannot make enough EPO. Low EPO levels cause your red blood cell count to drop and anemia to develop. Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys fail and can no longer make EPO.

Can erythropoietin cause blood clots? ›

Recent reports suggest a growing incidence of symptomatic venous thrombosis in cancer patients treated with recombinant erythropoietin. Several investigators have reported on different mechanisms of thrombosis in these patients.

Does EPO affect blood pressure? ›

Hypertension is the most frequent and most significant complication in Epo treatment. A rise in blood pressure or a need for augmentation of antihypertensive medications is demonstrated in approximately one third of Epo-treated patients.

How often do you have EPO injections? ›

It is usually injected one to three times weekly. When epoetin alfa injection products are used to decrease the risk that blood transfusions will be required due to surgery, it is sometimes injected once daily for 10 days before surgery, on the day of surgery and for 4 days after surgery.

How much does EPO injection cost? ›

The cost for Epogen injectable solution (2000 units/mL preservative-free) is around $359 for a supply of 10 milliliters, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.

Can EPO cause a stroke? ›

Erythropoietin in patients receiving hemodialysis is not associated with increased risk of stroke or any of its subtypes.

How does erythropoietin affect the heart? ›

In experimental models of cardiovascular and cerebrovascular disorders, EPO exerts protection by either preventing apoptosis of cardiac myocytes, smooth muscle cells, endothelial cells, or by increasing endothelial production of nitric oxide.

Does erythropoietin cause bone pain? ›

About 4 hours after the injection, the patient felt a back pain in the pelvic region. This is the first report of bone pain caused by erythropoietin.

What foods help repair kidneys? ›

The Best Foods for Kidney Health
  • Dark leafy greens. Dark leafy green vegetables such as kale, spinach, chard, and collard greens are loaded with vitamins A and C, calcium, and many other important minerals. ...
  • Berries. ...
  • Cranberries. ...
  • Sweet potatoes. ...
  • Olive oil. ...
  • Fatty fish. ...
  • Cabbage.

What are the 3 early warning signs of kidney disease? ›

Here are three signs that could indicate that you are beginning to experience a decline in kidney function.
  • Dizziness and Fatigue. One of the first possible signs of weakening kidneys is the experience of overall weakness in yourself and your overall health. ...
  • Swelling (Edema) ...
  • Changes in urination.

What level of creatinine indicates kidney failure? ›

Usually a creatinine level more than 1.2 for women and more than 1.4 for men may be a sign that the kidneys are not working like they should. If your serum creatinine test results are higher than normal, your doctor may want to run other tests. Glomerular filtration rate (GFR).

Is erythropoietin a chemotherapy? ›

Human recombinant erythropoietin (rhEpo) has been used for many years to treat chemotherapy and cancer associated anemia. The application of rhEpo resulted in an improved quality of life of patients and in a sparing of blood transfusions (1).

What should be monitored when taking epoetin? ›

It is very important that your doctor check the blood of you or your child on a regular basis while you are using this medicine. You may also need to monitor your blood pressure at home. If you notice any changes to your recommended blood pressure, call your doctor right away. .

What is the action of erythropoietin? ›

Erythropoietin (Epo) is a glycoprotein hormone produced in the kidney that acts on erythroid progenitor cells in the bone marrow. A negative feedback system, in which tissue oxygenation controls Epo production and Epo controls red blood cell (RBC) production, provides homeostasis in oxygen delivery to body tissues.

What are the effects of erythropoietin on the target cells? ›

Erythropoietin acts by binding to its cell surface receptor which is expressed at the highest level on erythroid progenitor cells to promote cell survival, proliferation, and differentiation in production of mature red blood cells.

What is the main effect of erythropoietin EPO A hormone secreted from the kidneys? ›

The hormone erythropoietin (Epo) maintains red blood cell mass by promoting the survival, proliferation and differentiation of erythrocytic progenitors. Circulating Epo originates mainly from fibroblasts in the renal cortex.

What are the benefits of taking erythropoietin? ›

Erythropoietin (EPO) helps your body maintain a healthy amount of red blood cells (erythrocytes). There's also a synthetic (man-made) form of erythropoietin that healthcare providers use to treat anemia that results from chronic kidney disease.

What are the symptoms of low erythropoietin? ›

Erythropoietin deficiency
  • fatigue.
  • light-headedness.
  • breathlessness.
  • weakness.
  • headaches.
  • pale skin.
  • heart palpitations.
Feb 26, 2021

Does erythropoietin increase blood pressure? ›

Hypertension is a common adverse effect of erythropoietin treatment among patients with chronic kidney disease (CKD) and even among healthy subjects who receive erythropoietin [1-3]. Hypertension has also been described following the use of other erythropoiesis-stimulating agents (ESAs) in patients with CKD [4].

How can I increase my EPO naturally? ›

Manipulating diet for protein and total calorie adequacy, monitoring hydration, using supplements, timing food combinations, adding weekly hypoxic exercise followed by easy or rest days all increases the release of natural EPO for healthy maximal oxygen carrying capacity.

How long does it take for EPO to increase hemoglobin? ›

It will take time for EPO medication to work in your body. Most people take 1 to 2 months to feel better.

What is the cost of erythropoietin injection? ›

Product Summary
Offer Price₹850.00
You Save₹150.00 (15% on MRP)
ContainsErythropoietin(4000.0 Iu)

How long does EPO stay in your system? ›

EPO has a relatively short half-life in serum (the half-life of rhEPO-a is 8.5 ± 2.4 hours when administered IV and 19.4 ± 10.7 hours when administered SC). [62] EPO is undetectable in urine after 3–4 days of injection.


1. What are erythropoietin-stimulating agents (ESAs)?
(You and MDS)
2. Red Blood Cells - Erythropoietin (EPO)
(Homework Clinic)
(Nephrology Extra Corporeal Group(NECG))
4. Role of (EPO) Erythropoietin injection in dialysis patients with CKD
(Nephrology Dialysis Therapist)
5. Injection Erythropoietin
(Nurses Handbook)
(Mole Rat Nation)
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