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Use of erythropoietins in patients with renal transplants

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3825 (Published 23 October 2009) Cite this as: BMJ 2009;339:b3825

Rapid Response:

Anemia and kidney function are related

Clearly it is important to know, if for kidney transplant patients
the same rules apply for the treatment with erythropoieseis stimulating
agents (ESA) as for dialysis patients or diabetic patients with impaired
renal function. The effort by Heinze et al. may therefore be a first step
to clarify this question. I see, however, a major drawback in their study.
And that is that is does not take into account transplant function (serum
creatinine or creatinine clearance). In table 1 are given a large number
of data about their population of kidney transplant patients but
creatinine is missing. In figure 4 the hazard ratios for mortality are
shown against the hemoglobin concentration in patients treated or not
treated with ESA. But how can the authors exclude that they are simply
comparing patients with different levels of renal function. If a patients
needs therapy with an ESA to reach a hemoglobin of say 13 his renal
function is likely to be worse than that of a patient reaching the same
hemoglobin without an ESA. It looks as if the difference between the 2
groups may not only be treatment with ESA but also different degrees of
transplant function which clearly has influence on survival.

Competing interests:
None declared

Competing interests: No competing interests

18 November 2009
Jan Gossmann
Nephrologist
Transplant clinic, KfH Nierenzentrum, Schleusenweg 22, 60528 Frankfurt am Main, Germany