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While the kidney is normally thought of as an excretory organ, it is also an important endocrine organ (ie, one that produces hormones). One of the hormones it produces is called erythropoietin (EPO), which stimulates the production of red blood cells (RBCs). RBCs are basically sacs of hemoglobin that carry oxygen around. The amount of hemoglobin varies according to the number of RBCs in the blood. And the number of RBCs in the blood is controlled by EPO. In kidney disease, EPO production decreases because the kidney is malfunctioning. As a result, RBC count decreases, as does hemoglobin.

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