Anemia is one of the most characteristic and visable manifestations of chronic renal failure. Investigators in the past decade have provided a better understanding of this anemia. The etiology of the anemia of chronic renal failure has three facets: first is reduced erythropoietin production by damaged kidneys; second is the presence of inhibitors to red blood cell (RBC) production in uremic serum; and third is red blood cell hemolysis. Unfortunately, transfusion therapy with its expense and risk of transmissable viral disease remains the mainstay of management for symptomatic anemia. Other modalities include dialysis, androgens, histidine supplementation, and erythropoietin replacement.