Benefits and concerns of treating pre-dialysis and renal transplant patients with recombinant human erythropoietin.

The possibility of lower efficacy and the fear of an increased incidence of side effects may explain the reluctance to use recombinant human erythropoietin (r-HuEPO) in patients with impaired renal function who do not yet require dialysis, as well as in transplanted patients with a failing renal allograft. Several recent studies have clearly shown that r-HuEPO is effective in these patient populations and that the doses needed to control anaemia are comparable with or lower than those needed for dialysis patients. When started at a low dose, the risk of severe hypertension is minimal, although in a significant number of patients intensification of the antihypertensive regimen is needed. Moreover, there are no indications that the use of r-HuEPO accelerates the deterioration of residual renal function.