What is identified as the primary cause of anemia in patients with end-stage renal disease (ESRD)?

The primary cause of anemia in patients with end-stage renal disease (ESRD) is erythropoietin deficiency. In healthy individuals, the kidneys produce erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow. However, in patients with ESRD, kidney function is significantly impaired, leading to reduced production of erythropoietin. This deficiency results in decreased red blood cell production, contributing to anemia.

While other factors, such as iron deficiency, vitamin B12 deficiency, and folate deficiency, can also play a role in anemia, they are often secondary to erythropoietin deficiency in the context of ESRD. In many cases, even if patients have adequate iron stores, the inability to produce sufficient erythropoietin remains the dominant factor leading to anemia in this patient population. Therefore, understanding the role of erythropoietin is crucial for effective management and treatment of anemia associated with ESRD.