Resumen de Assessment of initiation of erythropoietin treatment for anaemia and renal survival in non-dialysis chronic renal diseases patients. An observational study

Ranganathan Srinivasan, Ibel Chiramel Fredy, Santosh Chandraeshekar, Janarthanan Saravanan, Guru Prasad Mohanta, Prabal Kumar Manna

• Background and objectives: Currently, there is limited data demonstrating primary treatment for anaemia can extend renal survival among Chronic Kidney Disease (CKD) patients who are not on dialysis (NoD). Our study advocates the need to establish relationship between starting point/time of erythropoietin (EPO) therapy, haemoglobin (Hb) levels and renal consequence in NoD-CKD anaemic patients.

  Method: This is a prospective, observational study. Initially, non-dialysis CKD patients with anaemia who are naïve to Erythropoiesis-Stimulating Agents (ESA) were divided into three groups based on their Hb levels (Group I: Hb <9 g/dL, Group II: 9-10 g/dL and Group III: 10-11 g/dL). The primary endpoint was time to first event of any renal episode. Inverse probability weighted Poisson regression hazard model was used for survival analysis to adjust time-dependent selection bias in the artificially censored data. The secondary endpoint was occurrence of cardiovascular events and was analyzed by IPW method.

  Results: Total of 616 patients were eligible for key endpoint survival analysis. Significant incidental risk of renal events was higher in Group I compared with Group II and III. (HR, 3.52; 95% CI 2.06-3.68; P <0.0001); although not significant, incidental risk was also greater in Group II compared with Group I (HR, 2.48; 95% CI 1.12-2.4; P = 0.15). Secondary endpoint of cardiovascular events did not differ between Group II and Group III, and risk was higher in Group I than Group III but insignificant (HR, 1.94; 95% CI 0.96-3.94;

  P = 0.066).

  Conclusion: Initiation of ESA therapy in patients with decreased Hb levels below 10-11 g/dL was found to be more plausible at reducing the incidental risk of renal events in anaemic NoD-CKD patients when compared against starting ESA therapy at Hb levels below 9 g/dL or at even 10 g/dL.