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Nephrol Dial Transplant (2000) 15: 40-44
© 2000 European Renal Association-European Dialysis and Transplant Association

Early epoetin treatment in patients with renal insufficiency

Eberhard Ritz and Antje Eisenhardt

Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany

Historically, epoetin has been used to treat anaemia in patients already receiving renal replacement therapy. For many years, however, the results of early animal experiments raised considerable concern among nephrologists that disease progression would be accelerated if epoetin therapy were initiated in the pre-diaysis phase of renal failure. In retrospect, it has become clear that the results of these early animal experiments were confounded by a concomitant and uncontrolled rise in blood pressure. In subsequent studies in rat models, antihypertensive treatment effectively prevented the adverse effect on disease progression. In addition, the results of several small observational studies and one large controlled study suggest that the glomerular filtration rate is not adversely affected in pre-dialysis patients treated with epoetin as long as blood pressure is well controlled. There are several observations, though not definitive, which suggest that disease progression may even be slower when anaemia is reversed.

The benefits of early anaemia treatment with epoetin include increased exercise capacity and improved quality of life, cognitive function, and sexual function. Anaemia has also been identified as an important aetiological factor in the development of left ventricular hypertrophy. Whether pre-emptive treatment of anaemia is indicated in all pre-dialysis patients, or at least in those who develop progressive left ventricular hypertrophy, is currently under investigation.

Keywords: anaemia; blood pressure control; disease progression; epoetin; glomerular filtration rate; left ventricular hypertrophy

Correspondence and offprint requests to: Dr. Dr. h.c. mult. Eberhard Ritz, Department of Nephrology, University of Heidelberg, Bergheimer Straße 58, D-69115 Heidelberg, Germany


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