Table 2 Effects of subcutaneous titrated dosages of erythropoietin in patients not on dialysis on progression to renal replacement therapy

Dean et al. [55] (retrospective)

eGFR 30–59 mL/min/1.73 m² (n = 71)

eGFR <29 mL/min/1.73 m² (n = 51)

Hb = 10–11.9 g/dL or 8.0–9.9 g/dL

122 Only pts with ≥8 EPO doses included

EPO (Hb targets, doses not specified

Change in least-squares slope of inverse serum creatinine clearance vs time before and after EPO

Baseline eGFR 30–59 ml/min/1.73 m²:

Pre-EPO rate, dL/mg/yr:

-0.0981 (95% CI, -0.12, -0.07)

Post-EPO rate, dL/mg/yr: -0.0692 (95% CI, -0.09, -0.04)

Weighted mean difference, dL/mg/yr: 0.0454 (95% CI, 0.0150, 0.0757)

Baseline eGFR <29 ml/min/1.73 m²:

Pre-EPO rate, dL/mg/yr: -0.0899 (95% CI, -0.12, -0.06)

Post-EPO rate, dL/mg/yr: -0.0416 (95% CI, -0.06, -0.02)

Weighted mean difference, dL/mg/yr: 0.0493 (95% CI, 0.0272, 0.0679)

Overall:

Pre-EPO rate, dL/mg/yr: -0.0937 (95% CI, -0.11, -0.08)

Post-EPO rate, dL/mg/yr: -0.0569 (95% CI, -0.07, -0.04)

Weighted mean difference, dL/mg/yr: 0.0475 (95% CI, 0.0272, 0.0679) P < 0.05

CREATE study [61] (r)

eGFR 15–35 mL/min/1.73 m², Hb 11.0–12.5 g/dL;3 yrs

300

EPO to 13–15 g/dL

Time to dialysis (secondary) eGFR also assessed

Change of mean eGFR from baseline:

Year 1:

High-Hb group -3.6 ± 6.7 mL/min

Low-Hb group -3.1 ± 5.3 mL/min

Time to dialysis was significantly shorter in high-Hb group (P = 0.3)

300

EPO to 10.5–11.5 g/dL

Gouva et al. [58] (r, mc)

SrCr 2–6 mg/dL (eGFR not given), Hb 9.0–11.6 g/dL;22.5 mo

45

Early EPO to Hb≥3 g/dL

Composite of doubling of baseline SrCr, renal replacement or death

Composite endpoint: Early EPO pts, 29% Deferred EPO pts, 53%; P = 0.0078

Renal replacement: Early EPO pts, 22% Deferred EPO pts, 42%; P = 0.011

43

Deferred EPO when Hb<9.0 g/dL

Jungers et al. [59] (c-cs)

Predialysis (CrCl ≤15 mL/min) pts (eGFR not given); 24 mo

20 (Hb<10 g/dL)

EPO to 11.5 g/dL

Change-from-baseline rate of decline in creatinine clearance, time to dialysis

Rate of change in creatinine clearance, mL/min/1.73 m²/month: EPO group:

Baseline -0.36 ± 0.16

End of study -0.26 ± 0.15 (P < .05)

Standard care group:

Baseline -0.55 ± 0.48

End of study -0.57 ± 0.44

Time to dialysis: EPO group 16.2 ± 11.9 mo

Standard care group 10.6 ± 6.1 mo (P < 0.01).

43 (Hb>10 g/dL)

Standard care

Kuriyama et al. [79] (r)

SrCr 2–4 mg/dL (eGFR not given), Hematocrit<30%;28 mo median follow-up

31

Standard care

Doubling of baseline SrCr

Doubling of baseline SrCr

EPO, 52% of pts Standard care, 84% of pts

Nonanemic control, 60% of pts

Progression to dialysis:

EPO, 33% of pts

Standard care, 65% of pts (P = 0.008)

Nonanemic control, 37% of pts

42

EPO to Hct 33–35%

SrCr 2–4 mg/dL, Hematocrit>30%;28 mo median follow-up

35

Nonanemic control

Rossert et al. [66] (r, mc, uncontrolled)^a

Iothalamate GFR 25–60 mL/min; 40 mo

108

EPO for Hb 14–15 g/dL (men) and 13–14 g/dL (women)

Change-from-baseline GFR as estimated by iohexol clearance

GFR change:

High Hb group -0.058 mL/min/1.73 m²

Low Hb group -0.081 mL/min/1.73 m².

No significant difference between groups

133

PRN EPO for Hb 11–12 g/dL

Silverberg et al. [46] (nr)

Cockcroft-Gault eGFR decline >1 mL/min per mo; 11.8 mo

84 (NIDDM)

EPO to Hb 12.5 g/dL + IV Iron PRN

SrCr and CrCl (secondary endpoints)

GFR decline halted in both groups

95 (no NIDDM)