**3. Inflammation and anemia**

In dialysis patients, inflammation expressed by high levels of CRP is also associated with low blood hemoglobin and/or resistance to eritropoyesis-stimulating agents (Barany et al., 1997; Bradbury et al., 2009; Gunnel et al., 1999; Owen et al., 1998). This has been attributed to the inhibition of erythropoietin secretion by pro-inflammatory cytokines. Inflammation also contributes to anemia by inducing functional iron deficiency probably blocking the delivery of iron from the reticuloendothelial cells to the hemathopoietic cells. Cytokines may also induce ferritin synthesis directly or by increasing iron uptake into hepatocytes. The increase in ferritin synthesis by hepatocytes and reticuloendothelial cells underlies in the iron storage pool during inflammation. Thus, inflammation among patients with CKD can contribute to anemia and impaired response to erythropoietin. Erythropoietin resistance by itself has been associated with higher short-term mortality in CKD patients (López-Gómez et al., 2008).
