Partial correction of uraemic anaemia restores the baseline hyperkinetic haemodynamics toward normal, reduces left ventricular size and mass and improves exercise tolerance in dialysis patients. These effects may, in large part, be attributed to increases in haematocrit. Information on whether erythropoietin also acts directly on the heart, as it does on the peripheral vasculature, is not available. Also remaining unanswered is the question as to whether the effects of erythropoietin on the heart reduce cardiovascular mortality in end-stage renal disease (ESRD) patients. In addition, we do not know whether complete (vs partial) correction of uraemic anaemia will further enhance the beneficial effect of erythropoietin, or whether such gains could be counterbalanced by side effects of erythropoietin, such as the development or exacerbation of hypertension. Studies in the peripheral vasculature suggest erythropoietin also acts directly on the vascular smooth muscle cells, exerting both vasopressive and growth effects. Better understanding of the mechanism and control of such non-erythropoietic actions of erythropoietin can optimize the beneficial effect and minimize the side effect of this hormone on the cardiovascular system.