Treating anemia with recombinant human erythropoietin improves some quality of life measures, but does not slow decline in graft function in kidney transplant recipients, according to new study findings published in Experimental and Clinical Transplantation.

A hemoglobin (Hb) level of less than 11 g/dL has been associated with graft failure and mortality in recipients. Taryn Pile, MD, of Guys Hospital in the United Kingdom and her team conducted a randomized controlled trial of 55 kidney transplant recipients with iron-replete anemia 3 months after surgery not currently receiving erythropoiesis-stimulating agents (ESAs). Twenty-eight patients were treated with epoetin beta (starting dose: 50 U/kg/wk) to an Hb target of 11.5 to 13.5 g/dL and 27 received no treatment.

By 2 years, Hb had risen significantly higher in the epoetin beta group than in the no treatment group: 12.3 vs 9.99 g/dL. Concurrently, estimated glomerular filtration rate (eGFR), calculated by the Modified Diet in Renal Disease 7 study equation, declined by 1.7 vs 4.16 mL/min/1.73m2 in the treatment vs control groups, respectively. But the rate of kidney disease progression did not differ significantly between arms. The eGFR slope was -0.09 vs -0.12 mL/min/1.73m2, respectively, and investigators found no significant differences in proteinuria and blood pressure.

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Treated patients did experience improvement in quality of life, however. According to results from the Medical Outcomes Short Form Health Survey (SF-36), these patients had greater gains in the vitality and mental health domains compared with controls.

Treatment was not associated with adverse outcomes such as cardiovascular or thrombotic events.

This trial is an important addition to the literature in the treatment of anemia in transplant recipients, but larger studies are still needed to confirm safe use, according to the investigators. Results of this trial differ somewhat from the CAPRIT (Correction of Anemia Post-Kidney Transplant Reduces Progression of Allograft Nephropathy) study, they authors pointed out.

“Studies are needed to better understand the potential benefits and risks [of recombinant human erythropoietin], as well as to define safe target hemoglobin ranges in these patients,” Dr Pile and colleagues acknowledged.

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Pile T, Raftery M, Thuraisingham R, et al. Treating posttransplant anemia with erythropoietin improves quality of life but does not affect progression of chronic kidney disease. Exp Clin Transplant. 2019. doi:10.6002/ect.2018.0283