Low-dose subcutaneous erythropoietin corrects the anaemia of renal transplant failure

Although erythropoietin (Epo) is known to correct anaemia in dialysis and pre-dialysis patients, there is limited experience with its use in immunosup- pressed patients suffering from chronic renal graft dysfunction. We report the results of a pilot study of Epo in seven patients with failing grafts and normo- cytic normochromic anaemia attributable to renal failure. All entering patients had controlled blood pressure and serum ferritin > 100 µg/1. Three patients were taking triple immunotherapy (prednisone/aza- thioprine/cyclosporin), two patients prednisone/azathioprine, and two patients CsA monotherapy. Study duration mean was 15 ± 2 (sem) weeks, and Epo was started at 4000 units subcutaneously (s.c.) once weekly, adjusted to achieve a target haemoglobin (Hb) of 100 g/1. Mean Hb at initiation was 68 ± 5 g/1 and significantly increased to 96 ± 6 at end of follow- up, P< 10^-4. All patients responded. Maintenance Epo dosage was 120±32 U/kg bodyweight/week, roughly 4000 units/week. There was no significant change in serum creatinine: pre-study 392±45 µmol/ 1; post-study 430±62 µmol/1. There were no complications but blood pressure did rise significantly: pre- 124±ll/74±4mmHg to post- 142±10/86±3, P<0.05 for systolic and diastolic. Low-dose s.c. Epo effectively corrects anaemia in graft failure despite azathioprine and/or CsA therapy, without obvious acceleration of graft failure. Hypertension is a significant side-effect, but did not cause clinical problems. This induction dose by the s.c. route is lower than previously reported i.v. regimens, achieving a potential cost saving.