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

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.