Healthy kidneys produce a hormone called EPO. This hormone helps the bone marrow to make red blood cells, which then carry oxygen throughout the body. When the kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. There are other contributing causes to this anemia in kidney failure such as iron and vitamin deficiency, If left untreated, anemia can cause serious health problems. Having too little oxygen in the body can damage organs. With anemia, the heart must work harder to make up for the lack of red blood cells or hemoglobin leading to heart failure. Correcting of anemia in kidney disease is a complex situation with maintaining the hemoglobin levels within a narrow range (95-115). This requires specialist care with a combination of EPO supplementation, iron replenishment and constant monitoring.