Abstract
BackgroundAs 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.MethodsData 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.ResultsAt 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).ConclusionTreatment of the anemia of chronic renal failure with erythropoietin, when instituted together with vigorous metabolic control may slow the rate of renal function decline.
Highlights
As EPO treatment of chronic anemia of advanced renal disease is the standard of care we examined if such treatment may slow the progression of renal function decline
At month 0 the average blood pressure was 148/76 ± 5/4 mmHg and at month_12 the mean blood pressure was 145/73 ± 6/3 mmHg (p = 0.75 by 2 tailed paired Student's t test). 12/18 patients were on an angiotensin converting enzyme inhibitor (ACE-i) or ARB before month 0 and 14/18 were on it after (p = 0.71 by Fisher's 2 tailed exact test)
When linear regression analysis was applied to pre- and post-EPO 1/creatinine data the mean rate of 1/creatinine decline was -0.0140 ± 0.0119 and -0.0017 ± 0.0090 respectively
Summary
As EPO treatment of chronic anemia of advanced renal disease is the standard of care we examined if such treatment may slow the progression of renal function decline. As the renal function progressively declines complications of renal failure such as acidosis, uremia or volume overload become more and more significant and eventually may be the principal reason for the initiation of renal replacement therapy. These complications of chronic renal failure, can be managed for awhile with medical therapy. As the treatment of anemia of pre-ESRD patients with EPO is the standard of care we (page number not for citation purposes)
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