Renal function during erythropoietin therapy for anemia in predialysis chronic renal failure patients

Recombinant human erythropoietin (r-HuEPO) therapy for anemia in chronic renal failure patients could have unfavorable renal effects since reversal of anemia can raise blood pressure and accelerate experimental glomerular injury. Thus, the effects of r-HuEPO on renal and systemic hemodynamics and the progression of renal disease were studied in predialysis chronic renal failure patients. The clearances of inulin and p-amminohippurate, fractional excretions ofalbumin and immunoglobulin G, cardiac output, plasma renin activity and aldosterone concentration were assessed at baseline, after short-term r-HuEPO (n = 4) or placebo (n = 4) therapy, and after long-term r-HuEPO for all patients (n =8). In addition, the slope of 1/serum creatinine with time was determined before and during continued r-HuEPO therapy. In contrast to placebo therapy, hematocrit increased with r-HuEPO from 32 to 37% after 7.6 ± 2.7 weeks (mean ± SD). Antihypertensive drug therapy was increased in 2 patients in each group. Renal function, cardiac output, plasma renin activity and aldosterone did not change significantly in either group. After 18 ± 9 weeks oftherapy for all patients, hematocrit increased from 31 to 39%. Antihypertensive drug therapy was increased in 5patients and decreased in 1. Renal function decreased while proteinuria tended to increase. Cardiac output, plasma renin activity and aldosterone did not change. During 37 ± 22 weeks of r-HuEPO therapy, the slope of 1/serum creatininedid not worsen in any patient. Thus, when increases in blood pressure during r-HuEPO therapy are controlled, reversal of anemia into the low normal range in predialysis chronic renal failure patients does not appear to alter renal hemodynamics or accelerate progression of renal disease.