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The use of pretransplant erythropoietin to normalize hemoglobin levels has no deleterious effects on renal transplantation outcome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Renal section)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Renal section)
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2001 (English)In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 71, no 1, 79-82 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to establish the outcome of renal transplantation in patients given pretransplant erythropoietin (EPO) treatment targeted at reaching a normal hemoglobin concentration (Hb), compared to those given EPO-treatment aimed at maintaining subnormal Hb.

METHODS: A total of 416 patients from Scandinavian countries and with renal anaemia were enrolled to examine the effects of increasing Hb from a subnormal level (90-120 g/liter) to a normal level (135-160 g/liter) by EPO treatment. Half of the patients were randomized to have their Hb increased, with the other half randomized to maintain a subnormal Hb. Thirty-two patients from the normal Hb group and 24 patients from the subnormal group received a renal graft during the study period. The outcomes of these transplantations were examined prospectively for 6 months.

RESULTS: Preoperative Hb levels were 143+/-17 and 121+/-14 g/liter in the two groups, respectively (P<0.0001). The Hb remained higher in the normal Hb group during the first 2 weeks after transplantation. The percentage of patients requiring postoperative blood transfusions in the normal Hb group was 16%, compared with 50% in the subnormal group (P<0.01). No statistically significant difference in the proportion of functioning grafts or in the serum creatinine levels could be detected. No correlation between EPO treatment and creatinine levels after transplantation was found. The frequency of adverse events was similar in the two groups.

CONCLUSIONS: EPO treatment aimed at reaching a normal Hb in renal transplant recipients reduces the postoperative requirement for blood transfusions and has no deleterious effects on kidney graft function.

Place, publisher, year, edition, pages
2001. Vol. 71, no 1, 79-82 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-93118PubMedID: 11211199OAI: oai:DiVA.org:uu-93118DiVA: diva2:166498
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2010-10-14Bibliographically approved
In thesis
1. Effects of Hemoglobin Normalization with Epoetin in Chronic Kidney Disease
Open this publication in new window or tab >>Effects of Hemoglobin Normalization with Epoetin in Chronic Kidney Disease
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anemia is common in patients with chronic kidney disease (CDK), contributes to reduced Quality of Life (QoL) and is associated with cardiovascular disease, morbidity and mortality. Epoetin raises hemoglobin (Hb) and increases QoL and physical exercise capacity. Because of concerns about safety and economics, current anemia treatment with epoetin aims to achieve subnormal Hb (110-120 g/l). Normalization of Hb may be of additional benefit regarding QoL and cardiovascular effects. The present study examines the effects of Hb normalization with epoetin on safety variables, QoL, graft function after kidney transplantation, dialysis adequacy, hemorheology, hemodynamics and cardiac autonomic function in CKD patients.

In a randomized, multicenter study comprising 416 pre-dialysis and dialysis patients no difference was observed between patients treated to a normal or a subnormal Hb level on mortality, thrombovascular events, serious adverse events, vascular access thrombosis and residual renal function. QoL was enhanced in a subgroup of hemodialysis patients. Pretransplant epoetin treatment directed toward normal Hb levels did not result in worse graft function during 6 postoperative months. Dialysis adequacy was reduced in a subgroup of hemodialysis patients after normalization of Hb. The blood flow properties of pre-dialysis patients were altered. The hemorheological investigation demonstrated that Hb normalization caused a parallel increase in hematocrit and blood viscosity without other hemorheological changes. While the total peripheral resistance index increased, the cardiac index (CI) decreased. In a separate study cardiac autonomic function, measured by heart rate variability, was decreased in pre-dialysis patients. It was improved, but not fully normalized, by Hb normalization.

On the basis of this study, Hb normalization with epoetin appears to be safe and increases QoL in hemodialysis patients though may result in lower dialysis adequacy and increased blood pressure. A reduction in CI and improved cardiac autonomic function indicate a positive effect on cardiovascular function.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 44
Internal medicine, Anemia, blood viscosity, cardiac output, chronic kidney disease, renal dialysis, dialysis adequacy, erythopoietin, heart rate variability, hemoglobin, hemorheology, hypertension, kidney transplantation, Kt/V, left ventricular hypertrophy, Quality of Life, Invärtesmedicin
National Category
Clinical Medicine
urn:nbn:se:uu:diva-5816 (URN)91-554-6265-0 (ISBN)
Public defence
2005-05-31, Enghoffsalen, Ing. 50, Akademiska sjukhuset, Uppsala, 13:15
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2010-10-15Bibliographically approved

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