Role of uremic toxins in exacerbating anemia in renal failure

The anemia associated with renal failure is largely due to inappropriate er ythropoietin production. There is also good evidence, however, that substan ces present in uremic serum can inhibit erythropoiesis, although the exact identity of these substances and the mechanism(s) by which they exert this effect remain obscure. Candidates that have been suggested to play a role i n uremic inhibition of erythropoiesis include the polyamines (such as sperm ine, spermidine, putrescine, and cadaverine), parathyroid hormone, and some of the inflammatory cytokines. The potential role of each of these inhibit ory substances is discussed in this article.