Effect of Epoetin Induced Normal Hb on Progression ofNephropathy in Insulin Treated Diabetic Patients with RenalAnaemia

Background and aims: Haemoglobin (Hb) decreases were associated with progression of nephropathy and ithas been suggested that normal Hb levels may preserve renal function. Our aim was to investigate if this couldbe achieved by erythropoietin (EPO).Methods: A prospective randomized study of treatment with erythropoietin (EPO) was carried out in insulintreated diabetic patients with albuminuria, morning urine albumin 300 mg/l, and anaemia, Hb 110 g/l.EPO was given in order to achieve Hb levels 115 g/l (low) or 130 g/l (normal). The patients were followedfor one year and evaluated every third month with timed overnight urine collections, 24 hour blood pressuremeasurement and glomerular function (GFR) with iohexol clearance.Results: Twelve patients achieved 115 g/l and seven patients 130 g/l. The median GFR before treatment was26 (12-50) and 29 (15-53) ml/min/1.73m2 (median and min-max, p=NS). The median decrease in GFR permonth was faster in the patients with low Hb [- 1.0 (-2.89 to 0.25)] than in the normal Hb level group [-0.08(-1.08 to 1.16)] ml/min/1.73m2 per month (median and min-max, p= 0.015). Four patients were started ondialysis (n=2) or died (n=2), all in the low Hb group. Urine human complex (a-1-microglobulin) increased, i.e.proximal tubular function worsened, in the low Hb group with no change in the normal Hb group. Urine albumin,Immunoglobulin G, glycosaminoglycans, collagen IV non-collagenous part (NC1) and Tamm-Horsfall proteindid not change in any of the groups. Glycated haemoglobin (HbA1c) and blood pressure levels were unchangedin both groups.Conclusions: The present study infers that EPO treatment may preserve both glomerular filtration rate andproximal tubular function. Further studies are needed to confirm our findings.