MO973: Optimization of Erythropoietin Stimulating Agents for Post-Transplant Anemia in Kidney Recipients: Prospective Randomized Controlled Trial

Abstract

Abstract BACKGROUND AND AIMS Many studies suggested that chronic allograft nephropathy might progress faster in patients with PTA, but whether full correction of anemia improves renal outcomes is unknown. We aimed to assess the impact of full correction of chronic anemia in renal transplant recipients with stable graft function on patient and graft outcome along one year follow-up. METHOD We enrolled 247 kidney recipients with stable graft function to be assessed for anemia. Eligible patients were randomized to achieve target hemoglobin between 11:12 g/dL (group 1, n = 183) or 13:15 g/dl (in group 2, n = 64) using erythropoietin receptor stimulating agents (ESA). Monthly clinical and laboratory evaluation of kidney graft function was carried out. Quality of life was assessed at the start and 12 months. RESULTS More females were found in group 1 (68.9%) versus (50%) in group 2 (P = 0.007), and the original disease was chronic glomerulonephritis (37.5%) followed by diabetic nephropathy (DN) (15.7%) in group 2; but DN patients predominate in group 1(P = 0.005). The studied groups were comparable regarding pretransplant comorbidities. Most patients received thymoglobulin as induction and most of them were maintained on cyclosporine. We did not find any significant difference between the two groups concerning posttransplant diabetes, BK viremia or malignancies (P > 0.05); however, better graft function was observed in group 2 at 6 months (P < 0.05). We found that required ESA doses were significantly higher in patients of group 1 from the sixth month. Group 1 showed higher mean blood pressure (P = 0.003) while group 2 showed higher mean albumin (P < 0.05). Graft outcome was comparable in both groups (P = 0.125), but mortality cases were significantly higher in group 1 (16 cases, 8.7%) (P = 0.005). CONCLUSION Full correction of PTA in renal transplant recipients had no positive impact on graft outcome but it was associated with better patient survival possibly due improved cardiovascular risk.