Is Recombinant Human EPO Beneficial for Predialysis Patients?

Nineteen studies that included 993 subjects were assessed in the review
Nineteen studies that included 993 subjects were assessed in the review

Using recombinant human erythropoietin (rHuEPO) in predialysis patients helped correct their anemia without needing blood transfusions, according to a Cochrane Kidney and Transplant Group review. 

It has been established that treatment with rHuEPO in dialysis patients is highly effective in correcting anemia and improving their quality of life. The use of rHuEPO in predialysis patients, however, has been debated due to concerns of accelerating renal deterioration. Another viewpoint being that if rHuEPO is as effective in predialysis patients, an improved sense of well-being may delay the onset of dialysis. 

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Study authors searched the Cochrane Kidney and Transplant's Specialised Register (up to June 29, 2015) to provide an update on the 2005 review. They aimed to assess the effects of rHuEPO treatment in predialysis patients. Specifically regarding the timing of the onset of dialysis, correction of hemoglobin/hematocrit, improved quality of life, and whether it was associated with an increased incidence of adverse events (eg, hastened onset of dialysis, increased hypertension, arterio-venous fistulae clotting, seizures). 

A total of 19 studies that included 993 subjects were assessed in the review. Improvements in hemoglobin (MD 1.90g/L, 95%CI: -2.34 to -1.47) and hematocrit (MD 9.85%, 95% CI: 8.35 to 11.34) were seen with rHuEPO treatment as well as a decrease in the number of patients requiring blood transfusions (RR 0.32, 95% CI: 0.12 to 0.83). The rHuEPO treatment group also demonstrated improvements in quality of life and exercise capacity. 

The review did not show a statistically significant difference for most of the measures of kidney disease progression. Researchers also stated that they were unable to assess the effects of rHuEPO on the delay in the onset of dialysis or adverse events.  

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