Epoetin alfa and darbepoetin alfa: effects on ventricular hypertrophy in patients with chronic kidney disease

BACKGROUND: Anemia is very common in chronic kidney disease (CKD) and is commonly treated with recombinant human erythropoietin. The aim of this study was to analyze the efficacy of epoetin alfa and darbepoetin alfa on left ventricular parameters in patients with CKD. METHODS: Patients with CKD not yet dependent on dialysis were randomly assigned to treatment with epoetin alfa at weekly intervals (Epo group; baseline hemoglobin 8.5 +/- 0.8 mg/dL, creatinine clearance 10.0 +/- 2.0 ml/min per 1.73 m2) or darbepoetin alfa every 2 weeks (Dar group; baseline hemoglobin 8.2 +/- 0.8 mg/dL, creatinine clearance 10.8 +/- 2.4 ml/min per 1.73 m2). Patients not receiving erythropoietin served as a control group. Two-dimensional color Doppler echocardiography was performed at baseline and at 24 weeks to measure left ventricular mass index (LVMI) and ejection fraction. RESULTS: Hemoglobin in the 2 treatment arms was corrected to 10.6 +/- 0.6 mg/dL and 10.7 +/- 0.5 mg/dL for Epo and Dar groups, respectively. The LVMI decreased significantly in both the Epo (-5.7 +/- 14.2 g/m2) and the Dar group (-5.6 +/- 15.8 g/m2) but increased in the control group (9.0 +/- 15.1 g/m2; p=0.02, between the Epo and control groups, and between the Dar and control groups). The ejection fraction was increased in both treatment groups (Epo group: 2.45% +/- 2.28%, Dar group: 1.64% +/- 2.95%) and decreased in controls (-1.15% +/- 3.69%) (p=0.004 among groups). The 2 treatment groups showed similar efficacy. The degree and the change of renal function did not differ among the 3 groups at end of study. CONCLUSIONS: The 2 erythropoiesis-stimulating agents epoetin alfa and darbepoetin alfa, when given to patients with CKD in doses aimed at standard anemia correction are associated with a similar degree of LVMI reduction, in the absence of a concomitant enhancement of CKD progression.