NDT Advance Access originally published online on September 12, 2006
Nephrology Dialysis Transplantation 2007 22(3):784-793; doi:10.1093/ndt/gfl483
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Is early treatment of anaemia with epoetin-
beneficial to pre-dialysis chronic kidney disease patients? Results of a multicentre, open-label, prospective, randomized, comparative group trial
1The Renal Unit, King's College Hospital, Denmark Hill, London SE5 9RS, 2Heartlands Hospital, Renal Unit, Bordesley Green, Birmingham B9 5SS and 3SW Thames Renal & Transplant Unit, St Helier Hospital, Carlshalton, Surrey SM5 1AA, UK
Correspondence and offprint requests to: Dr Iain C. Macdougall, Consultant Nephrologist, The Renal Unit, King's College Hospital, Denmark Hill, London SE5 9RS, UK. Email: Iain.Macdougall{at}kingsch.nhs.uk
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Abstract |
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Background. This multicentre, open-label prospective, randomized, comparative-group study evaluated the effects of maintaining haemoglobin (Hb) in pre-dialysis chronic kidney disease (CKD) patients.
Methods. A total of 197 patients were randomized to start subcutaneous epoetin-
(SC-EPO; EPREX®; 1000 U twice weekly) at an early stage of anaemia to maintain Hb at 11.0 ± 1.0 g/dl (group A, n = 65), or to allow Hb to fall to 
9.0 g/dl before starting SC-EPO (group B, n = 132) (2000 U three times weekly); and subsequently maintaining Hb at 11.0 ± 1.0 g/dl.
Results. Of 132 patients randomized to group B, 55 progressed to treatment (-trigger). The study was prematurely terminated due to contraindication of the subcutaneous administration route. Mean weekly EPO doses at 1 year were 1471 U for group A; 820 U for group B; final doses were 2281 U for group A; 2099 U for group B. There was no significant difference between groups A and B with regard to left ventricular mass (–12.5 vs –9.7%; P = 0.82). In groups A and B, 48% and 52%, respectively, terminated the study because of dialysis/death, after a median of 36.3 and 27.3 months, respectively.
Conclusion. Early intervention to correct anaemia in CKD patients did not have a significant impact on LVM, the primary efficacy variable. Time to dialysis/death was not significantly different between groups A and B.
Keywords: anaemia; chronic kidney disease; early treatment; epoetin-; pre-dialysis
Received for publication: 27. 9.04
Accepted in revised form: 18. 7.06
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