Recombinant Human Erythropoietin Therapy in Predialysis Patients of Chronic Kidney disease

Abstract

Renal anemia is a well recognized complication of chronic kidney disease with erythropoietin deficiency being the primary cause. Erythropoiesis-stimulating agents (ESAs), introduced almost two decades ago, have replaced blood transfusions as first line therapy for anemia. They have been shown to markedly improve the quality of life but the effects on blood pressure and rate of progression of disease are still a matter of controversy. This prospective interventional study aimed to determine the efficacy and safety of recombinant human erythropoietin therapy (rHuEPO) in correction of renal anemia, ascertain its effect on progression of renal excretory function and assess the quality of life in predialysis patients of chronic renal failure. We prospectively studied 50 anemic (hemoglobin levels <10.0 g/dL) predialysis patients of chronic renal failure (GFR between 15–90 mL/min/1.73 m2). The children, under 14 years of age, and were randomly selected in the outpatient clinic at The Children's Hospital and Institute of Child Health Lahore, Pakistan between July 2007 to June 2008. These patients were treated with rHuEPO for 48 weeks. The maintenance dose of subcutaneous rHuEPO used was 100 U/kg/week given twice weekly along with oral iron and folate supplementation. Patients underwent clinical and laboratory evaluation during the trial period. GFR was calculated using the Schwartz formula. The mean age of the children enrolled in the study was 7.68 years at presentation with male to female ratio of 1.63. Hemoglobin and GFR values before initiation of rHuEPO treatment were 8.20∓1.28 g/dL and 29.82∓12.00 mL/min/1.73 m2 as compared to the final results of 10.94∓1.04 g/dL and 32.36∓11.24 mL/min/1.73 m2, respectively. Only 4 (8%) patients developed end – stage renal disease by the end of the study period and had to begin dialysis while others continued with the conservative management of chronic renal failure. No significant side – effects were seen in any of the study population like hypertension, seizures or hyperviscosity syndrome, except 3 (6%) children who required increase in dose of antihypertensive medication. The health – related quality of life improved in terms of physical performance and sense of well being in the majority of subjects. Our study provides conclusive evidence that rHuEPO therapy is beneficial for correction of renal anemia with substantial retardation of maintenance dialysis in the majority of predialysis patients with chronic kidney disease.