Epoetin May Be Renoprotective in Transplant Recipients

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DENVER—Renal transplant recipients who receive epoetin (EPO) treatment for post-transplant anemia may experience slower declines in kidney function, a study found.

A team at the J.W.Goethe University Hospital Frankfurt (Frankfurt am Main, Germany) led by Ingeborg A. Hauser, MD, studied 207 anemic kidney transplant recipients who received epoetin for at least six months. Subjects had a mean age of 47 years at transplantation and 52.4 years at the start of EPO therapy. The investigators gathered information on estimated glomerular filtration rate (eGFR), concomitant medication use, rejection episodes, hematological parameters, and cardiovascular events from 12 months prior to EPO treatment to 24 months after the start of EPO.

Hemoglobin levels significantly increased from 10.4 to 12.4 g/dL within three months of EPO treatment. The mean eGFR (in mL/min/1.73m2), as calculated using the Modification of Diet in Renal Disease study formula, was 44.3 at discharge, 40.8 one year post-transplant, 39.9 one year pre-EPO treatment, and 35.3 at the start of EPO, and 35.7 and 34.7 at 12 and 24 months after the start of EPO, respectively.

The mean yearly loss of eGFR (in mL/min/1.73m2), pre-EPO therapy was 5.7. This decreased significantly to 0.85 after 24 months of EPO treatment. During the 24 months of EPO therapy, 18 patients (9.2%) experienced cardiovascular events, none of them were fatal, one patient died after cystectomy due to bladder carcinoma, and four patients experienced graft loss during the 24 months EPO therapy.

“Employing ESA treatment to correct anemia [in renal transplant recipients] is efficacious and safe,” Dr. Hauser told Renal & Urology News. “In addition EPO seems to have a renoprotective effect on GFR of renal allografts. The latter finding should be confirmed in a prospective trial and might be a way to improve  longterm renal allograft survival.”

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