Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients

Background. Partial correction of anaemia with recombinant human erythropoietin (rHuEpo) has been shown to markedly improve the general condition and quality of life of predialysis patients, but the effects of rHuEpo therapy on blood pressure and the rate of progression of chronic renal failure (CRF) are still disputed. In particular, no study evaluated the time duration until the start of maintenance dialysis in treated patients, compared to untreated predialysis patients. Methods. We retrospectively evaluated the rate of decline of creatinine clearance (ΔCcr) and the duration of the predialysis period in 20 patients with advanced CRF treated with rHuEpo (Epo+ group), and in 43 patients with a similar degree of CRF but with less marked, asymptomatic anaemia, not requiring rHuEpo therapy (Epo− group). All patients were submitted to identical clinical and laboratory surveillance. All received similar oral supplementation with B6, B9, and B12 vitamins and oral iron supplementation. Maintenance dose of subcutaneous epoetin was 54.3±16.5 U/kg/week (median dose 3300 U/week). Results. Initial and final haemoglobin (Hb) levels were 8.8±0.7 and 11.3±0.9 g/dl in the Epo+ group, vs 10.9±1.2 and 9.5±0.9 g/dl in the Epo− group. In the Epo+ group, ΔCcr declined from 0.36±0.16 during the preceding 24 months to 0.26±0.15 ml/min/ 1.73 m2/month after the start of rHuEpo therapy (P