***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE The use of erythropoietin ( EPO ) for the amelioration of anemia has dramatically changed the quality of life of the patients with chronic renal failure ( CRF ) . The efficacy of a low dose EPO therapy was assessed in the prospect i ve 6 week trial . METHODS Assessment of hematological parameters and iron stores was done in 40 patients of CRF : Group A--20 patients of CRF receiving 40 U/kg EPO biweekly for 6 weeks and Group B--20 patients of CRF not receiving EPO .  The parameters were studied at the start and at 2 , 4 and 6 weeks of the study . RESULTS A statistically significant rise in mean haemoglobin levels ( 7.27 + /- 1.26 g/dl to 8.60 + /- 1.66 g/dl ) ; mean packed cell volume ( 21.4 + /- 4.04 % to 25.4 + /- 6.54 % ) and mean reticulocyte count ( 1.28 + /- 0.4 % to 2.14 + /- 0.86 % ) was observed on EPO therapy . Patients on EPO developed a significant decline in serum iron , serum ferritin levels , bone marrow iron stores ; and a hypochromic-microcytic picture on the peripheral blood film suggestive of iron deficiency . Iron deficiency at the start , chronic infections like tuberculosis and inadequate haemodialysis were identified as causes of hyporesponsiveness to EPO therapy . Low dose EPO therapy was not associated with any major adverse effects . CONCLUSIONS Low dose EPO ( 40 U/kg , biweekly ) therapy is safe and effective in the management of anaemia of CRF Results from animal experiments have suggested that treatment with recombinant human erythropoietin ( rHuEPO ) causes changes in renal hemodynamics which are detrimental to renal function . Therefore , the effects of correction of the anemia by rHuEPO on glomerular filtration rate ( GFR ; inulin clearance ) and effective renal plasma flow ( ERPF ; PAH clearance ) were studied in eight pre-dialysis patients . The studies were done before ( Hct 0.24 + /- 0.05 liter/liter ) and at 89 + /- 19 days after the start of rHuEPO therapy ( Hct 0.39 + /- 0.03 liter/liter ) . To further evaluate the effects of ACE inhibition , 25 mg of captopril was given orally after baseline values had been obtained . Baseline GFR , renal blood flow ( RBF ) and filtration fraction ( FF ) did not change during rHuEPO therapy . At low hematocrit ( Hct ) captopril induced a significant increase in ERPF and RBF , and a decrease in MAP . After correction of the hematocrit the blood pressure lowering effect of captopril remained unchanged . However , captopril no longer induced changes in ERPF and RBF . We conclude that the increase in hematocrit had no adverse effects on GFR . The results suggest that changes in hematocrit may influence the effects of ACE inhibition on efferent vascular resistance . Therefore , the hematocrit should be taken into account when evaluating studies on the effects of ACE inhibition in the progression of chronic renal failure A study was undertaken to ascertain the effects of recombinant human erythropoietin ( r-HuEPO ) on renal function in chronic renal failure predialysis patients . The effect of improvement of anemia by r-HuEPO on the rate of decline in renal function in predialysis patients has not been previously studied prospect ively in a large number of patients using reliable measures of glomerular filtration rate ( GFR ) . To investigate the efficacy , safety , and impact of r-HuEPO therapy in chronic renal insufficiency patients , a 48-week , r and omized , open-label , multicenter study was initiated in 83 anemic , predialysis ( serum creatinine 3 to 8 mg/dL ) patients . Serial GFRs were measured using 125I-iothalamate clearance . Forty patients were r and omized to the untreated arm and 43 patients to the treatment arm ( 50 U/kg r-HuEPO  subcutaneously three times weekly ) . Baseline characteristics were comparable for the r-HuEPO-treated and untreated groups . During this 48-week study , GFR , mean arterial blood pressure , and daily protein intake were not significantly different between the two groups . There was a statistically significant increase in hematocrit for the r-HuEPO-treated group that was not associated with acceleration of deterioration in residual renal function . This was demonstrated by the lack of a significant ( P = 0.376 ) between-group difference in mean change in GFR from baseline to last available value for the r-HuEPO-treated ( -2.1 + /- 3.2 mL/min ) and untreated ( -2.8 + /- 3.5 mL/min ) groups . This study concludes that r-HuEPO therapy improves  anemia in predialysis patients and does not accelerate the rate of progression to end-stage renal disease Abstract A prospect i ve r and omized study of the use of recombinant human erythropoietin ( rHuEPO ) in children with chronic renal disease was conducted to assess dosing requirements and side effects . Forty-four children with chronic renal failure , aged 4 months to 21 years , were studied . Twenty-five patients were pre dialysis , 10 on peritoneal dialysis , and 9 on hemodialysis .  Patients received either 150 U/kg per week or 450 U/kg per week divided thrice weekly of rHuEPO for 12 weeks or until target hemoglobin ( Hb ) was attained . Dose was then adjusted to maintain a normal Hb . Eighty-two percent of patients reached target Hb by 7.9±5.6 weeks ( mean±SD ) ; 95 % of patients in the high-dose group and 66 % in the low-dose group reached target Hb within 12 weeks . The overall median rHuEPO dose at target Hb was 150 U/kg per week . Hemodialysis patients tended to require more rHuEPO to maintain a normal Hb ( median 250 U/kg per week ) . Transfusion requirements and panel-reactive antibody levels decreased during the 12 weeks . Iron deficiency and /or hypertension occurred in 30 % of children . In conclusion , rHuEPO at 150 U/kg per week is safe and effective in treating anemia in children with chronic renal disease The investigators evaluated the impact of recombinant human erythropoietin ( r-HuEPO ) therapy on health-related quality of life ( HRQL ) in predialysis chronic renal disease patients with anemia . Eighty-three patients were entered into a r and omized , parallel-group , open-label clinical trial with follow-up evaluations over 48 weeks . Forty-three patients were assigned to r-HuEPO treatment , and 40 patients were assigned to an untreated control group .  Hematocrit levels were measured at baseline and monthly . HRQL was assessed at baseline and at weeks 16 , 32 , and 48 . The HRQL assessment included measures of physical function , energy , role function , health distress , cognitive function , social function , home management , sexual dysfunction , depression , and life satisfaction . Significant improvements in hematocrit levels were observed in the r-HuEPO-treated group ( P < 0.0001 ) , and no changes were seen in the untreated group . Correction of anemia ( hematocrit > or = 36 ) occurred in 79 % of r-HuEPO-treated patients and 0 % of control patients . Significant improvements in assessment s of energy ( P < 0.05 ) , physical function ( P < 0.05 ) , home management ( P < 0.05 ) , social activity ( P < 0.05 ) , and cognitive function ( P < 0.05 ) were found for the r-HuEPO-treated group . No changes were observed in the control group , except for a decrease in physical function ( P < 0.05 ) . Between-group differences favoring the r-HuEPO-treated group were found for energy ( P < 0.05 ) and physical functioning ( P < 0.05 ) . In patients receiving r-HuEPO , significant improvements were seen in hemotocrit levels , and these increases result ed in improvements in HRQL Renal anaemia is an independent risk factor for the development of left ventricular hypertrophy ( LVH ) , heart failure and mortality . Studies show that partial correction of anaemia leads to partial regression of LVH . However , early initiation of anaemia therapy may be the optimal way to reduce cardiac morbidity and mortality . The Cardiovascular risk Reduction by Early Anemia Treatment with Epoetin Beta ( CREATE ) trial will investigate the effect of early anaemia correction on cardiovascular risk reduction in patients not yet on renal replacement therapy . The primary objectives of this open , r and omized , multicentre trial are to investigate the effect of early anaemia correction on the change in left ventricular mass index after 1 year , and the time to first cardiovascular event . The trial comprises two treatment arms : early intervention where patients will receive epoetin beta when their haemoglobin ( Hb ) level is 11 - 12.5 g/dl and their target Hb will be 13 - 15 g/dl , and late intervention , where patients will receive epoetin beta once their Hb level is < 10.5 g/dl and their target Hb will be 10.5 - 11.5 g/dl . The study will be event-driven with a continuous evaluation and an interim analysis once every year . The inclusion of 600 patients is based on assumption of a 15 - 20 % event rate in the control group and that 200 events are needed to detect a reduction of about one-third . In conclusion , the CREATE trial will examine whether early anaemia treatment will prevent development of LVH , reduce cardiovascular morbidity and provide other benefits The final development of the Sickness Impact Profile ( SIP ) , a behaviorally based measure of health status , is presented . A large field trial on a r and om sample of prepaid group practice enrollees and smaller trials on sample s of patients with hyperthyroidism , rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses . Test-retest reliability ( r = 0.92 ) and internal consistency ( r = 0.94 ) were high . Convergent and discriminant validity was evaluated using the multitrait – multi method technique . Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores . The relationship between the SIP and criterion measures were moderate to high and in the direction hypotheszed . A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis . The final SIP contains 136 items in 12 categories . Overall , category , and dimension scores may be calculated BACKGROUND Partial correction of renal anaemia with erythropoietin improves quality of life ( QoL ) . We aim ed to examine if normalization of haemoglobin with epoetin alfa in pre-dialysis and dialysis patients further improves QoL and is safe . METHODS 416 Sc and inavian patients with renal anaemia [ pre-dialysis , haemodialysis ( HD ) and peritoneal dialysis patients ] were r and omized to reach a normal haemoglobin of 135 - 160 g/l ( n=216 ) or a subnormal haemoglobin of 90 - 120 g/l ( n=200 ) with or without epoetin alfa .  Study duration was 48 - 76 weeks . QoL was measured using Kidney Disease Question naires in 253 Swedish dialysis patients .  Safety was examined in all patients . RESULTS QoL improved , measured as a decrease in physical symptoms ( P=0.02 ) , fatigue ( P=0.05 ) , depression ( P=0.01 ) and frustration ( P=0.05 ) in the Swedish dialysis patients when haemoglobin was normalized . In pre-dialysis patients , diastolic blood pressure was higher in the normal compared with the subnormal haemoglobin group after 48 weeks . However , the progression rate of chronic renal failure was comparable . In the normal haemoglobin group ( N-Hb ) , 51 % had at least one serious adverse event compared with 49 % in the subnormal haemoglobin group ( S-Hb ) ( P=0.32 ) . The incidence of thrombovascular events and vascular access thrombosis in HD patients did not differ . The mortality rate was 13.4 % in the N-Hb group and 13.5 % in the S-Hb group ( P=0.98 ) . Mortality decreased with increasing mean haemoglobin in both groups . CONCLUSIONS Normalization of haemoglobin improved QoL in the subgroup of dialysis patients , appears to be safe and can be considered in many patients with end-stage renal disease PURPOSE The purpose of this study was to determine the efficacy of recombinant human erythropoietin ( rHuEPO ) given subcutaneously three times/week in patients with chronic renal failure and anemia ( predialysis ) . PATIENTS AND METHODS Eleven patients with predialysis chronic renal failure participated in a double-blind , placebo-controlled study of subcutaneously administered erythropoietin . For 12 weeks 
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REVIEW ER 'S CONCLUSIONS This review has shown that treatment with rHu EPO in pre-dialysis patients corrects anaemia and avoids the requirement for blood transfusions .
There are also improvements in quality of life and exercise capacity .
There may be increased hypertension .
In the long term , questions still remain about whether pre-dialysis rHu EPO either speeds up or delays the onset of dialysis .
Thus there is insufficient evidence on the total costs and benefits of treating pre-dialysis patients with rHu EPO