I am a kidney doctor. Mr Brown, a frail 79 year old man who lives in social housing, comes to my clinic. He has advanced chronic renal failure, cause unknown, but not so far advanced that dialysis would be likely to benefit him, and in previous discussion with me and the dialysis nurses he has said that he doesn't want it in the future anyway. He tells me that he is tired, has no energy, and getting around is more of an effort than it used to be, but he is eating satisfactorily and his diagnosis is that he thinks he's getting old. His haemoglobin is 101 g/l.

I suspect that he would feel better if his haemoglobin was higher. He is not iron deficient. Erythropoietin would be the most appropriate treatment on clinical grounds and …