Nephrol Dial Transplant (1992) 7: 811-816
© 1992 European Renal Association-European Dialysis and Transplant Association
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Erythropoietin for anaemia in haemodialysis patients: results of a maintenance study (The Canadian Erythropoietin Study Group)
1Department of Medicine, University of Western Ontario 2Robarts Research Institute London, Ontario, Canada
Correspondence and offprint requests to: Correspondence and offprint requests to: Dr N. Muirhead, Division of Nephrology, University Hospital, P.O. Box 5339, 339 Windermere Road, London, Ontario, Canada N6A 5A5
Most published studies of recombinant human erythropoietin (rHuEpo) have been of limited duration and in small patient populations. The present study examines the long-term effects of rHuEpo in 98 haemodialysis patients treated for up to 18 months. All patients had completed a 6 month placebo-controlled study of rHuEpo. Patients previously on placebo (group 1; n = 31) received rHuEpo at an initial dose of 50 U/kg thrice weekly with subsequent dose adjustments to maintain haemoglobin (Hb) in the range 105–120 g/l. Patients previously on rHuEpo (group 2; n = 67) continued on their usual dose with adjustments made to maintain Hb at 105–120 g/l. Haematological parameters were measured every 2 weeks. Quality of life, assessed by a disease-specific kidney disease questionnaire (KDQ), was measured every 6 months. Mean Hb in group 1 increased from 74.2±11.4 g/l at baseline to 112.9±12.6 g/l after 12 months of rHuEpo therapy. After 12 weeks of rHuEpo therapy Hb in groups 1 and 2 was indistinguishable. Hb remained constant in both groups throughout the period of follow-up. Mean rHuEpo dose requirements were similar in both groups. At the end of the study the mean intravenous rHuEpo dose in group 1 patients was 176.6±154.4 and in group 2 patients was 210.0 ± 144.0 U/kg per week. Access failure was increased during rHuEpo therapy in patients with synthetic grafts (46% versus 7% failures compared to fistulae; P<< 0.001). Group 1 patients receiving rHuEpo had a significant increase in diastolic but not systolic blood pressure despite a32% increase in overall antihypertensive prescrip-tions. Group 1 patients experienced an improvementin KDQ scores comparable to that seen in group 2patients. The improved KDQ scores were maintainedthroughout the study, indicating a sustained andclinically significant improvement in disease-specificquality of life. It is concluded that prolonged treat-ment with rHuEpo for the anaemia of chronic renalfailure is associated with a sustained improvement inquality of life and an acceptably low morbidity.Patients with synthetic access may be vulnerable toan increased access failure rate and may require alower target Hb.
Keywords: erythropoietin; anaemina; haemodialysis; quality of life
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