Biosynthetic failure refers to the aspects of uremia from loss of the renal hormones 1,25 (OH) 3 vitamin D3 and erythropoietin. The kidneys are primarily responsible for the secretion of erythropoietin and 1-a-hydroxylase, which is necessary to produce the active form of vitamin D 3. In ESRD patients, levels of both these hormones are significantly depressed. Since 85 percent of erythropoietin is produced in the kidneys, ESRD patients have depressed levels, contributing to anemia. Vitamin D 3 deficiency results in decreased gastrointestinal (GI) calcium absorption, inducing secondary hyperparathyroidism, responsible for the development of renal bone disease.
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