October 2012, Updated February 2015
According to the U.S. Centers for Diseases Control and Prevention, 1 in 10 of Americans suffer chronic kidney disease. In addition to genetics (i.e. African Americans, Native Americans, and Hispanics) and aging, the leading causes of chronic kidney disease are diabetes and high blood pressure.
In addition to removing the body’s wastes and excess water, the kidneys produce erythropoietin (EPO). EPO is a hormone that stimulates the bone marrow to produce more red blood cells. If the kidneys cannot make enough EPO, then the red blood cell count drops, and anemia develops.
Today, physicians treat kidney disease patients with erythropoiesis-stimulating agents (ESAs) like Epogen (approved by the Food and Drug Administration in 1989).  Since iron also contributes to red blood cell production, both ESA treatment and iron supplementation are necessary to manage kidney disease.
By boosting red blood cell count, EPO ensures that more oxygen is transported to muscles. Increased oxygen to muscles leads to longer muscular performance – especially helpful in endurance-related athletic activities like horse racing, marathons, cycling, triathlons, etc.
When used solely to enhance athletic performance, ESAs are dangerous because athletes dehydrate due to vigorous exercise, which increases the thickness (viscosity) of their blood, and raises the risk for heart attacks and strokes. ESAs, including Epogen, are the same performance-enhancing substances that U.S. and international associations have banned and that resulted in Lance Armstrong’s demise.
ESAs also boost the red blood cell count making the blood “thick”, and irresponsible use results in clots causing strokes, heart attacks, and death. Susan Black, author of “Blood Medicine: Blowing the Whistle on One of the Deadliest Prescription Drugs Ever” attributes blood doping to “our get-rich, quick-fix, more-is-better culture”.
At the 56th American Society of Hematology (ASH) Annual Meeting and Exposition, researchers suggested that a new class of agents, known as activin receptor fusion proteins, may encourage healthy red blood cells to mature and proliferate, providing a much-needed alternative to current options. A separate study suggests that the amino acid L-glutamine may support healthy red blood cell growth, diminishing the complications of anemia with minimal side effects. Julie Panepinto, MD, MSPH, moderator of the ASH press conference and professor at the Medical College of Wisconsin and Children’s Hospital of Wisconsin in Milwaukee concluded, “We are optimistic about new strategies being presented today to support healthy red blood cell production without causing additional complications for these chronically ill patients.”
To boost red blood cell production without medications, transfusions, ESAs or surgery, individuals should avoid alcohol and aspirin, increase exercise and eat a balanced diet. A diet rich in iron, Vitamin B12 and folic acid (including foods such as lentils, liver, green leafy vegetables, etc.) is one healthful way to boost healthy red blood cells. Iron supplements taken at safe dosages or under a physician’s supervision also continue to be another safe and healthy option.
 Erythropoietin < http://en.wikipedia.org/wiki/Erythropoietin > (accessed Oct 31, 2012)
 National Kidney Foundation, Managing Anemia When You Are on Dialysis, 2006
 Kathleen Sharp, “A Drug to Quicken the Blood”, The New York Times, October 11, 2012
 “New Strategies Boost Healthy Red Blood Cell Production to Target Anemia Across a Range of Blood Disorders”, December 7, 2014 < http://www.hematology.org/Newsroom/Press-Releases/2014/3482.aspx > (accessed Feb 10, 2015)