To examine the effects of erythropoietin on the anemia of chronic renal disease and on the rate of renal deterioration, we administered recombinant human erythropoietin to 17 patients with anemia and progressive renal failure who did not yet require dialysis (serum creatinine level, 353 to 972 mumol per liter [4.0 to 11.0 mg per deciliter]). The dose of erythropoietin (50 to 150 units per kilogram of body weight) was adjusted according to the hematocrit response. In all 17 patients the anemia responded to erythropoietin. The median hematocrit increased from 0.27 to 0.37. The rate of the response depended on the initial erythropoietin dose and was similar to that observed in patients who were on dialysis. Hypertension was present in 14 patients before therapy, developed during therapy in 2 of the normotensive patients, and worsened in 9 patients, who required additional antihypertensive medications. The rate of the decline in renal function, as measured by serial determination of the reciprocal of the serum creatinine level, did not change significantly as the hematocrit rose (P = 0.78 by the paired t-test) during erythropoietin therapy. All the patients reported improvements in appetite, activity level, and sense of well-being. We conclude that erythropoietin therapy is effective in correcting the anemia of patients with progressive renal failure without affecting renal function, although it may be associated with an increase in blood pressure.

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Clinical outcome audit was carried out on two groups of obese out‐patients for a 3‐month follow‐up period. In the first audit group of 35 patients (A1), energy intake was prescribed by diet history, whereas in the second audit group of 27 patients (A2) energy intake was prescribed from an estimate of individual energy requirements based on age, sex and activity. There was no significant difference in age or initial BMI between the two groups and the failure‐to‐attend rate was the same in each group. Patients in Group A2 received e significantly higher energy prescription (P<0.001) than Group Al, but this was still significantly more restricted than the recommended 500 kcal energy deficit from energy expenditure (P<0.05). Weight loss was significant in both groups, but was greater in Group A2 than in Group A1. There was no significant correlation between weight loss and energy deficit. In a selected group of patients from Group A2 who were prescribed energy intake close to the recommended deficit of 500 kcal. weight loss was found to be significantly greater (P<0.05) when compared to the weight loss in Group Ai. Results suggest that a diet prescription with an energy deficit below the estimated energy requirements does not lead to greater weight loss and probably reduces compliance. Estimating individual energy requirements rather than using dietary assessment may improve weight loss.