title: Correction of postkidney transplant anemia reduces progression of allograft nephropathy.
abstract: Retrospective studies suggest that chronic allograft nephropathy might progress more rapidly in patients with post-transplant anemia, but whether correction of anemia improves renal outcomes is unknown. An open-label, multicenter, randomized controlled trial investigated the effect of epoetin-β to normalize hemoglobin values (13.0-15.0 g/dl, n=63) compared with partial correction of anemia (10.5-11.5 g/dl, n=62) on progression of nephropathy in transplant recipients with hemoglobin <11.5 g/dl and an estimated creatinine clearance (eCrCl) <50 ml/min per 1.73 m(2). After 2 years, the mean hemoglobin was 12.9 and 11.3 g/dl in the normalization and partial correction groups, respectively (P<0.001). From baseline to year 2, the eCrCl decreased by a mean 2.4 ml/min per 1.73 m(2) in the normalization group compared with 5.9 ml/min per 1.73 m(2) in the partial correction group (P=0.03). Furthermore, fewer patients in the normalization group progressed to ESRD (3 versus 13, P<0.01). Cumulative death-censored graft survival was 95% and 80% in the normalization and partial correction groups, respectively (P<0.01). Complete correction was associated with a significant improvement in quality of life at 6 and 12 months. The number of cardiovascular events was low and similar between groups. In conclusion, this prospective study suggests that targeting hemoglobin values ≥13 g/dl reduces progression of chronic allograft nephropathy in kidney transplant recipients.
authors.affiliation: Nephrology, Dialysis, Transplantation and Intensive Care Department, Centre Hospitalier Universitaire (CHU) Amiens, Hôpital Sud, ERI-12 Institut National de la Santé et de la Recherche Médicale, Jules Verne University, 80054 Amiens Cedex 1, France. choukroun.gabriel@chu-amiens.fr
authors.forename: Gabriel
authors.initials: G
authors.lastname: Choukroun
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dussol
authors.forename: Isabelle
authors.initials: I
authors.lastname: Etienne
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cassuto-Viguier
authors.forename: Olivier
authors.initials: O
authors.lastname: Toupance
authors.forename: François
authors.initials: F
authors.lastname: Glowacki
authors.forename: Bruno
authors.initials: B
authors.lastname: Moulin
authors.forename: Yvon
authors.initials: Y
authors.lastname: Lebranchu
authors.forename: Guy
authors.initials: G
authors.lastname: Touchard
authors.forename: Maïté
authors.initials: M
authors.lastname: Jaureguy
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pallet
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Meur
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Frank
authors.initials: F
authors.lastname: Martinez
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications / Q000188:drug therapy*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D018450:Disease Progression; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000517:prevention & control; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D014184:Transplantation, Homologous
chemical_list: D000959:Antihypertensive Agents; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin