Correction of postkidney transplant anemia reduces progression of allograft nephropathy

Abstract

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-b 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 m2. 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 amean 2.4ml/min per 1.73m2 in the normalization group comparedwith 5.9 ml/min per 1.73m2 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 survivalwas 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. Copyright © 2012 by the American Society of Nephrology.