Erythropoietin safety and efficacy in chronic allograft nephropathy.
BACKGROUND
Patients with chronic allograft nephropathy (CAN) very frequently suffer anemia. Correction of anemia by means of recombinant erythropoietin (rEpo) is possible and useful, but safety and efficacy must be assessed.


METHODS
This multicenter, prospective, open study included patients with a cadaver renal transplant, CAN, and non-ferropenic anemia. The aim of the study was to determine the safety and efficacy of treatment with rEpo to target hematocrit (HCT) values around 35% and/or hemoglobin (Hb) levels of 11 g/dL.


RESULTS
Twenty-four patients were included: 71% males and 29% females aged 49.5 +/- 14 years. At last follow-up, 48% did not show anemia-related symptoms, and 19% experienced adverse events possibly or probably related to rEpo. In 86% of cases, anemia was corrected and in 71%, graft survival was conserved. Patients whose anemia was not corrected had poor initial renal function (sCr 5 +/- 1 mg/dL vs sCr 3.2 +/- 1 mg/dL, P = .028). Patients with graft survival showed correction of anemia (P = .001) on a relatively low dose of rEpo and without a significant increase in blood pressure.


CONCLUSIONS
All patients who had graft survival and only half of those who lost their graft showed a correction of anemia. The rEpo treatment neither accelerated nor decelerated renal failure. The difference between patients in whom anemia was corrected, or not, did not depend upon the previous level of HCT/Hb, but upon worse renal function. Thus, rEpo in patients with CAN is safe and effective, so administration should be initiated early to avoid adverse events deriving from anemia.
Baltar
J
J
Hospital Universitario Central de Asturias and Hospital Clinic i Provincial de Barcelona, Barcelona, Spain. jbaltar@hca.es
Moran
N
N
Ortega
F
F
Ortega
T
T
Rebollo
P
P
Cofan
F
F
Campistol
J M
JM
D000328:Adult; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D001794:Blood Pressure; D002102:Cadaver; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D004921:Erythropoietin / Q000592:standards / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000473:pathology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012449:Safety; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000473:pathology
D004921:Erythropoietin; D003404:Creatinine