Aim: The aim of this paper is to review the emerging evidence supporting erythropoietin therapy in improving the long-term prognosis of patients with renal failure, by correcting underlying anaemia. Methods: This paper reviews and discusses data from several large retrospective databases containing the demographic and treatment details of many thousands of patients with renal insufficiency. Each investigation selected for review used appropriate statistical methodologies to determine the effects of erythropoietin on morbidity and mortality. Results: There is a clear link between anaemia and the development of cardiovascular dysfunction. This is an important finding given that more than 90% of patients become anaemic as a consequence of renal failure. Database analysis has also shown that treatment of anaemic dialysis patients with erythropoietin significantly reduces mortality, often by more than 20%, primarily through effects on the cardiovascular system. In addition, improvements in the exercise capacity and quality of life of patients have been observed despite many patients entering dialysis with a considerable burden of ill health, particularly cardiovascular dysfunction. Conclusions: Retrospective database analyses have provided a clear understanding of the advantageous effects of erythropoietin treatment on morbidity and mortality in patients with end-stage renal disease. The implications of these findings for further improving treatment strategies in patients with renal insufficiency point to erythropoietin use before the onset of dialysis.