18,19 So increase of GDF11 levels may be involved in erythropoietin-resistant anemia, which is often observed in uremic patients.20 Since a poor initial hematopoietic response to erythropoietin is associated with adverse cardiovascular events in diabetic patients with uremia,20 pharmacological upregulation and/or supplementation of GDF11 may not exert beneficial effects on aging-related disorders, such as cardiovascular disease in HD patients. This evidence concerns the gene GDF11 and uremia.