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2013, Number 3

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Revista Habanera de Ciencias Médicas 2013; 12 (3)

Treatment with recombinant erythropoietin, left ventricular hypertrophy and balance benefit-risk in CKD-3b

Pérez-Oliva DJF, Casanova GM, Cuesta PO, Bencomo RO, López TB, González C, Cruz BL, García GI, Tuero IÁD, Valenzuela SCM, López SPA

Language: Spanish
References: 25
Page: 472-486
PDF size: 241.38 Kb.


ABSTRACT

Introduction: renal anemia is a frequent complication among patients with chronic kidney disease (CKD). The introduction of recombinant erythropoietin (rhuEpo) treatment has changed anemia management, but the therapeutic hemoglobin (Hb) target is still under debate, and clinical evidence for its effect on cardiac functions is in discussion.
Objective: this study aimed to explore the effect of pre-dialysis erythropoiesis-stimulating agent (ESA) use on the left ventricular hypertrophy (LVH) or general and renal function protective effect in CKD3b-4 patients. Different than in introducción in Spanish.
Patients and methods: open multicentric assay. A 56-week follow-Up dose-response study. The change from baseline to the end of treatment was calculated for glomerular filtration rate by MDRD (GFR,) and, LVH by echocardiography at 24 months.
Results: the treatment significantly increased hematocrit (Htc) in all patients who completed the study (n = 33, 0.29 ± 0.02(V%) versus 0.38 ± 0.03, P (Wilcoxon)= 0.000. In the beginning 90,9% At the end only the 78.8% the patients had LVH, it was decreased 2.2 mm (14 a 11.8 mm), and significant reverse lineal correlation between the change in the LVH and Hb concentration was noted (r = -0.379; p = 0.030). Progression of the CKD was slow (mL/min). Diabetics 37.2 ± 8.4 versus 34.7 ± 6.7 (p Wilcoxon=0.119) non diabetics 35.1 ± 7.833.6 ± 7.7 (p Wilcoxon= 0.119). 48.5% of the patients had Adverse effects (AE). No patients died or started in dialysis. The Balance Benefit- Risk (AE moderate or severe) estimated from the Bayes Factor was evidence to the benefit (BF=1, 64).
Conclusion: we observed that correction of anemia with rhuEpo in patients with CKD 3b seems to improve the LVH without another problems and it is beneficial. The results of this study support the treatment of severe anemia with EPO.


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