Target Higher Hb May Be Renoprotective in Tx Patients

DENVER—Researchers have reported on what they believe is the first prospective, randomized study to show that targeting a serum hemoglobin (Hb) level of 13 g/dL or higher has a renoprotective effect in kidney transplant patients.

In a study of 125 renal transplant recipients, Gabriel Choukroun MD, PhD, of Hôpital Sud, in Amiens, France, and collaborators used subcutaneous epoetin beta to treat post-transplant anemia using two Hb targets: 13-15 g/dL (group A, 63 patients) and 10.5-11.5 g/dL (group B, 62 patients). The objective was to evaluate the effect on chronic allograft progression (CAN).

Subjects had their allografts for at least 12 months and had an Hb level below 11.5 g/dL. Their estimated glomerular filtration rate (eGFR) was 20-50 mL/min/1.73 m² at study inclusion. The two groups had similar baseline Hb levels (10.4 and 10.6 g/dL for groups A and B, respectively) and eGFR (34.4 and 33.7 mL/min/1.73 m²).

After 12 months, the Hb level in group A was significantly higher than in group B (13.4 vs. 11.2 g/dL). The levels were 12.9 and 11.3 g/dL after two years’ follow up, also a significant difference.

At one year, the eGFR was significantly higher in group A than group A (35.9vs. 30.8 mL/min/1.73 m², the researchers reported. This difference also was significant after two years (32.6 vs. 27.9 mL/min/1.73 m²). In addition, significantly more patients in group B than group A reached end-stage renal disease before two years of follow-up (13 vs. 3). Four patients died during the study, one in group A and three in group B. Death-censored graft survival was 20% greater in group A than group B. At the end of the study, 89% of patients in group A and 61% in group B were receiving epoetin beta, according to the investigators. Weekly doses were 5,600 UI and 4,600 UI, respectively, they noted.

Dr. Choukroun and colleagues observed no significant difference in the incidence of adverse events between groups. The number of cardiovascular events was low and similar between groups, according to the investigators.