Nephrol Dial Transplant (2002) 17: 60-66
© 2002 European Renal Association-European Dialysis and Transplant Association
Contribution of anaemia to progression of renal disease: a debate
1 Department of Nephrology, Tenon Hospital, Paris, France, 2 Georgia Medical Care Foundations, Atlanta, USA, 3 Department of Renal Medicine, Gosford Hospital, Sydney, Australia, 4 Nephrology Section, Academisch Ziekenhuis, Brussels, Belgium and 5 Department of Nephrology and Dialysis, Medical University Clinic III, Vienna, Austria
Abstract
It is hypothesized that anaemia contributes to the progression of renal disease via hypoxia and oxidative stress. These effects may stimulate the production of extracellular matrix by fibroblasts, increasing interstitial fibrosis and leading to tubular destruction. Recombinant human erythropoietin (r-HuEPO, epoetin) has antioxidative and anti-apoptotic properties, though these effects have yet to be demonstrated in renal cells. In theory, epoetin treatment might slow the progression of renal failure, not only by correcting anaemia but also via direct effects on tubular and vascular cell survival. Alternative hypotheses suggest, however, that epoetin could have negative effects on the kidney because of its vasoconstrictive action, which is independent of haemoglobin levels. Retrospective and prospective clinical studies clearly show that epoetin does not accelerate progression of renal disease, provided that blood pressure is well controlled. Some studies suggest that epoetin slows the progression of renal failure, although this remains a controversial issue, as all these studies have methodological limitations. Larger randomized controlled trials and meta-analysis of the existing trials are required to establish whether treatment of anaemia with epoetin can indeed slow the progression of renal disease.
Keywords: anaemia; blood pressure; epoetin; renal failure; r-HuEPO
Notes
Correspondence and offprint requests to: Jérôme Rossert, Department of Nephrology, Tenon Hospital, 4 Rue de la Chine, 75970 Paris Cedex 20, France. Tel: +33 156016029, fax: +33 156016999, e-mail: jerome.rossert{at}tnn.ap\|[hyphen]\|hop\|[hyphen]\|paris.fr
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