Correction of Postkidney Transplant Anemia Reduces Progression of Allograft Nephropathy

• Published in: Journal of the American Society of Nephrology Vol. 23; no. 2; pp. 360 - 368
• Main Authors: CHOUKROUN, Gabriel, KAMAR, Nassim, JAUREGUY, Maïté, PALLET, Nicolas, LE MEUR, Yannick, ROSTAING, Lionel, MARTINEZ, Frank, DUSSOL, Bertrand, ETIENNE, Isabelle, CASSUTO-VIGUIER, Elisabeth, TOUPANCE, Olivier, GLOWACKI, François, MOULIN, Bruno, LEBRANCHU, Yvon, TOUCHARD, Guy
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society of Nephrology 01.02.2012
• Subjects: Adult; Aged; Anemia - complications; Anemia - drug therapy; Anemias. Hemoglobinopathies; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Clinical Research; Disease Progression; Diseases of red blood cells; Erythropoietin - adverse effects; Erythropoietin - therapeutic use; Female; Glomerular Filtration Rate; Hematologic and hematopoietic diseases; Hemoglobins - analysis; Humans; Immunosuppressive Agents - therapeutic use; Kidney Diseases - prevention & control; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - prevention & control; Kidney Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Quality of Life; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Transplantation, Homologous; Kidney disease; Nephrology; Urinary system disease; Nephropathy; Prognosis; Anemia; Homograft; Graft; Evolution; Hemopathy; Urology
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/asn.2011060546

Retrospective studies suggest that chronic allograft nephropathy might progress more rapidly in patients with post-transplant anemia, but whether correction of anemia improves renal outcomes is unknown. An open-label, multicenter, randomized controlled trial investigated the effect of epoetin-β to normalize hemoglobin values (13.0-15.0 g/dl, n=63) compared with partial correction of anemia (10.5-11.5 g/dl, n=62) on progression of nephropathy in transplant recipients with hemoglobin <11.5 g/dl and an estimated creatinine clearance (eCrCl) <50 ml/min per 1.73 m(2). After 2 years, the mean hemoglobin was 12.9 and 11.3 g/dl in the normalization and partial correction groups, respectively (P<0.001). From baseline to year 2, the eCrCl decreased by a mean 2.4 ml/min per 1.73 m(2) in the normalization group compared with 5.9 ml/min per 1.73 m(2) in the partial correction group (P=0.03). Furthermore, fewer patients in the normalization group progressed to ESRD (3 versus 13, P<0.01). Cumulative death-censored graft survival was 95% and 80% in the normalization and partial correction groups, respectively (P<0.01). Complete correction was associated with a significant improvement in quality of life at 6 and 12 months. The number of cardiovascular events was low and similar between groups. In conclusion, this prospective study suggests that targeting hemoglobin values ≥13 g/dl reduces progression of chronic allograft nephropathy in kidney transplant recipients.