[Frequency of anaemia and indications for treatment with epoetin in chronic renal failure at the pre-dialysis stage].
OBJECTIVE
To determine the degree of anaemia corresponding to the decreasing levels of renal function in patients with chronic renal failure (CRF) and not yet on dialysis, and to assess the indications for treatment with recombinant erythropoeitin (epoetin).


METHODS
We studied the relationship between haemoglobin (Hb) concentration and creatinine clearance (Ccr) in 403 consecutive patients with CRF regularly monitored in nephrology consultations between January 1 and June 30, 1999, and who received appropriate iron and vitamin supplementation. These patients were then followed-up until June 30, 2000 or until maintenance dialysis was initiated.


RESULTS
There was a significant and close correlation between the degree of anaemia and renal dysfunction. An Hb value<11 g/dl (corresponding to the present threshold for the indication of epoetin) was observed in 62% of patients with creatinine levels>400 micromol/l and in 58% when Ccr was<20 ml/mn/1.73 m2. Whatever the level of CRF, the degree of anaemia was higher in the women than in the men. Among the 123 patients who had to start maintenance dialysis during the observation period, 85 (69%) were treated with epoetin before dialysis was started.


CONCLUSIONS
In patients with CRF, clinically symptomatic anaemia is more frequent than imagined, and early treatment is required. Regular monitoring of Hb and iron levels is mandatory in order to allow patients to benefit from timely initiation of epoetin and thus prevent the development of disabling asthenia and other deleterious consequences of anaemia.
Jungers
Pierre-Yves
PY
Services de néphrologie et de biochimie A, Hôpital Necker, Paris, France.
Nguyen-Khoa
Thao
T
Joly
Dominique
D
Choukroun
Gabriel
G
Massy
Ziad A
ZA
Jungers
Paul
P
D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012737:Sex Factors; D013997:Time Factors
D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D003404:Creatinine; D007501:Iron