r.hu-Erythropoietin (EPO) treatment of pre-ESRD patients slows the rate of progression of renal decline

BMC Nephrology

Manuel Perera-Chong¹  Satoshi Kadomatsu²  Mihály Tapolyai² 

[1] Clinical Management Europe, Fresenius Medical Care, USA;Department of Nephrology and Hypertension, Cleveland Clinic Florida, USA

Others  :  1083454
DOI  :  10.1186/1471-2369-4-3

 received in 2002-12-12, accepted in 2003-06-17,  发布年份 2003

【 摘 要 】

Background

As EPO treatment of chronic anemia of advanced renal disease is now the standard of care we examined if such treatment may slow the progression of renal function decline.

Methods

Data of 18 pre-ESRD patients were analyzed retrospectively 12 months prior and prospectively 12 months after the initiation of EPO. Mean creatinine was 5.0 ± 1.8 mg/dL (Mean ± SEM) when starting EPO at a weekly dose of 5000 ± 500 units once the hematocrit was below 30 %. EPO dose was titrated monthly for a hematocrit between 33.0% and 37.0%. Metabolic complications and hypertension were controlled.

Results

At month_0 the average blood pressure was 148/76 ± 5/4 mmHg and at month_12 it was 145/73 ± 6/3 mmHg (p = 0.75 by 2 tailed paired Student's t test). 12/18 patients were on an ACE-i or ARB before month_0 and 14/18 were on it after (p = 0.71 by Fisher's 2 tailed exact test). The average hematocrit rose from 26.9% ± 0.6 to 33.1 % ± 0.1. When linear regression analysis was applied to pre- and post-EPO 1/creatinine data the mean rate of decline was -0.0140 ± 0.0119 (mean ± SD) and -0.0017 ± 0.0090 (non-parametric Wilcoxon matched pairs signed rank sum test: Z value: -2.91; P = 0.004) respectively. 5/18 patients did not require dialysis 12 months after starting EPO (month_0).

Conclusion

Treatment of the anemia of chronic renal failure with erythropoietin, when instituted together with vigorous metabolic control may slow the rate of renal function decline.

【 授权许可】

   
2003 Tapolyai et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Lafferty HM, Garcia DL, Rennke HG, Troy JL, Anderson S, Brenner BM: Anemia ameliorates progressive renal injury in experimental DOCA-salt hypertension. J Am Soc Nephrol 1991, 1(10):1180-5.
• [2]Garcia DL, Anderson S, Rennke HG, Brenner BM: Anemia lessens and its prevention with recombinant human erythropoietin worsens glomerular injury and hypertension in rats with reduced renal mass. Proc Natl Acad Sci U S A 1988, 85(16):6142-6.
• [3]Kleinman KS, Schweitzer SU, Perdue ST, Bleifer KH, Abels RI: The use of recombinant human erythropoietin in the correction of anemia in predialysis patients and its effect on renal function: a double-blind, placebo-controlled trial. Am J Kidney Dis 1989, 14(6):486-95.
• [4]Yagil Y: Proposed therapeutic algorithm for the treatment of anemia of chronic renal failure in pre-dialysis patients with low dose once weekly subcutaneous r-HuEPO. Multicenter Study Group, Israel. Isr J Med Sci 1997, 33(1):36-44.
• [5]Rutherford WE, Blondin J, Miller JP, Greenwalt AS, Vavra JD: Chronic progressive renal disease: Rate change of serum creatinine concentration. Kidney Int 1977, 11:62-70.
• [6]Mitch WE, Walser M, Buffington GA, Lemann J: A simple method of estimating progression of chronic renal failure. Lancet 1976, 18:1326-1328.
• [7]Lim VS, Fangman J, Flanigan MJ, DeGowin RL, Abels RT: Effect of recombinant human erythropoietin on renal function in humans. Kidney Int 1990, 37(1):131-6.
• [8]Roth D, Smith RD, Schulman G, Steinman TI, Hatch FE, Rudnick MR, Sloand JA, Freedman BI, Williams WW Jr, Shadur CA, et al.: Effects of recombinant human erythropoietin on renal function in chronic renal failure predialysis patients. Am J Kidney Dis 1994, 24(5):777-84.
• [9]Krmar RT, Gretz N, Klare B, Wuhl E, Scharer K: Renal function in predialysis children with chronic renal failure treated with erythropoietin. Pediatr Nephrol 1997, 11(1):69-73.
• [10]Kuriyama S, Tomonari H, Yoshida H, Hashimoto T, Kawaguchi Y, Sakai O: Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron 1997, 77(2):176-85.
• [11]Jungers P, Choukroun G, Oualim A, Robino C, Nguyen AT, Man NK: Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients. Nephrol Dial Transplant 2001, 16:307-312.
• [12]Kuriyama S, Hopp L, Yoshida H, Hikita M, Tomonari H, Hashimoto T, Sakai O: Evidence for amelioration of endothelial cell dysfunction by erythropoietin therapy in predialysis patients. Am J Hypertens 1996, 9(5):426-31.
• [13]Frenken LA, Wetzels JF, Sluiter HE, Koene RA: Evidence for renal vasodilation in pre-dialysis patients during correction of anemia by erythropoietin. Kidney Int 1992, 41(2):384-7.