Naslov
Does correction of anemia improve renal function in CKD patients?

Autori
Bubić, Ivan ; Devčić, Bosiljka ; Rački, Sanjin

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, ostalo

Izvornik
Acta Med Croatica / - , 2008

Skup
5. hrvatski konfres nefrologije, dijalize i transplantacije

Mjesto i datum
Bol, Hrvatska, 18.04.2008. - 21.04.2008

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
anemija; kronična bubrežna bolest
(Anemia; Chronic Kidney Disease)

Sažetak
Introduction: Anemia is a key feature of chronic kidney disease (CKD) and may develop at any time after onset of renal failure. Usually develops in stage III and IV of CKD, well before the onset of end stage renal disease (ESRD). Anemia is an important clinical factor for the patients with advanced CKD. In addition to iron and vitamin supplementation, erythropoietin (Epo) administration is advised for renal anemia treatment according to clinical guidelines. The renoprotective effect of Epo is very controversial. It has been reported that Epo can slow the decline of renal function in predialysis CKD patients. However, in the recent large-scale randomized controlled trials, CREATE and CHOIR, the renoprotective effect of Epo was not observed. The aim of this study is to determine whether the Epo treatment of predialysis CKD patients may improve their renal function. Methods: We have prospectively studied during the 12 months a group of 10 randomly selected outpatient Epo naive predialysis patients with stage 3 and 4 of CKD and renal anemia (Group 1). Subcutaneous Epo treatment was initiated at day 0. Patient follow up was done every 3 months by physical examination, blood pressure measuring and blood samples were taken for laboratory analyses. Blood samples were analyzed for hemoglobin (Hb), urea, creatinin, sodium and potassium level in the plasma and estimated glomerular filtration rate (GFR) was calculated for each patient according to the MDRD formula. As a control group we randomly assigned 10 predialysis patients that were examined in our outpatient department between 2005. and 2007., not receiving Epo (Group 2). This group of patients was studied retrospectively and the same parameters were monitored in the period of one year. Results: Patients from both groups had an estimated GFR of 15 to 35 ml/min/1.73m2 and mild to moderate anemia according to the NKF-K/DOQI clinical practice guidelines (2002). Mean age of the patients in Group 1 and 2 was 71, 4 and 71, 2 year, respectively, with the higher prevalence of males (70% and 80%). Mean Hb level at day 0 was 108, 5 and 108, 1 g/L, respectively. Mean estimated GFR was 24, 9 for the patients in the Group 1 versus 22, 3 ml/min/1.73m2 in the Group 2. After one year follow-up there was a significant difference in Hb level and estimated GFR between these two groups. Namely, there was an increase of mean Hb level of 1, 81% and a decrease of mean estimated GFR of -15, 81% in Group 1. In the Group 2 a decrease of mean Hb level of 1, 30% and 36, 32% of mean estimated GFR were observed. Furthermore, a strong correlation between Hb level and concentration of serum creatinine was also observed in Group 1 whereas there was no correlation for the same parameters in Group 2. Interestingly, both groups showed no correlation between Hb level and estimated GFR. Conclusion: Results observed in this study show that Epo treatment of renal anemia can improve or at least slow decline of renal impairment and progression of CKD. This is in according with the initiative of Croatian Society for Nephrology, Dialysis and Transplantation for covering the Epo treatment expenses not only for ESRD but also for the CKD patients by Croatian Institute for Health Insurance. However, these are just a preliminary results and including of more patients on Epo therapy is needed.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA