Treatment of anemia in renal transplantation: impact of a stricter application of hemoglobin targets.
OBJECTIVE
The CREATE and CHOIR studies showed a higher risk for cardiovascular events associated with hemoglobin (Hb) values >13 g/dL in patients with stage 3-4 chronic kidney disease. In 2007, a stricter policy on the use of erythropoietin (EPO) was adopted at our center, with an Hb target of 11 to 12 g/dL and withdrawal or reduction of EPO when Hb was >12.5 to 13 g/dL. This study was designed to evaluate this new approach.


METHODS
The study included patients under follow-up at the transplant outpatient clinic on December 31, 2006 (n = 725), and December 31, 2007 (n = 768). Data were compared between the study populations concerning renal function, Hb, use of EPO, and associated costs.


RESULTS
No significant differences in creatinine or Hb values were observed between the 2 groups (1.47 +/- 0.6 vs 1.42 +/- 0.9 mg/dL and 13.7 +/- 1.5 vs 13.7 +/- 1.6 g/dL, respectively). After implementation of the new protocol, the frequency of severe anemia (Hb <11 g/dL) increased (2% vs 4%; P = .10), the use of EPO decreased (22.1% vs 17.2%; P = .017), and the mean Hb of EPO-treated patients decreased (12.5 +/- 1.4 vs 11.9 +/- 1.0; P < .001). The Hb target (11-12 g/dL) was met in fewer than one third of patients, with no significant differences between the 2 study times.


CONCLUSIONS
A strict policy on EPO application reduces its use and the rate of patients with "excessive" Hb values (which are associated with increased cardiovascular risks), with an acceptable slight increase in severe anemia cases.
Gentil
M A
MA
Nephrology Unit, Hospital Virgen del Rocío, Seville, Spain. mgentil@cica.es
Pérez-Valdivia
M A
MA
González-Roncero
F M
FM
López-Mendoza
M
M
Cabello
V
V
Bernal
G
G
Suñer
M
M
Pereira
P
P
D000328:Adult; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003404:Creatinine / Q000378:metabolism; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D004921:Erythropoietin; D003404:Creatinine