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Anemia, or low red cell count, low hemoglobin concentration, and low hematocrit, is seen sooner or later in many cases of renal failure. Anemia occurs in patients with kidney failure because the hormone that signals the bone marrow to produce more red cells, erythropoietin, is synthesized in the kidney, and this process may be inadequate in people with kidney disease. Anemia in patients with chronic renal failure may cause shortness of breath on exertion and even frank heart failure. Anemia severe enough to cause symptoms is seen in about one-third of patients.

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