Possible mechanisms of anemia in older adults. A hyperinflammatory state is typical in anemia of inflammation (AI), CKD, and inflammaging. This state is characterized by increased hepcidin production in the liver, resulting in a direct negative impact on erythropoiesis and increased iron retention in the reticuloendothelial system (RES). Moreover, production of EPO is insufficient in response to anemia, and EPO response in the erythropoiesis is blunted. A further hallmark in the pathogenesis of AI is the increased phagocytosis of aging erythrocytes (eryptosis). Clonal disorders in leukocytes increase the risk of developing cardiovascular complications and anemia. This association may be caused by the promotion of inflammatory processes. Plus signs symbolize stimulation, and minus signs inhibition.