Siamopoulos KC et al. (2006) Long-term treatment with EPO increases serum levels of high-density lipoprotein in patients with CKD. Am J Kidney Dis 48: 242–249

Data indicate that abnormal serum lipid parameters—for example, decreased levels of HDL cholesterol—might contribute to the high incidence of cardiovascular complications in patients with chronic kidney disease (CKD). A previously published randomized controlled trial showed that administration of recombinant human erythropoietin (EPO) during the early stages of CKD slows disease progression. Now, in a nested sub-study of the original trial, the authors have examined how EPO influences serum lipid profiles in the predialysis CKD population.

Forty-five of 88 patients with stage 3 or 4 CKD were randomly assigned to receive subcutaneous epoetin alfa (50 U/kg/week, with a hemoglobin target of at least 130 g/l). The remaining 43 patients received epoetin alfa only if their hemoglobin level dropped below 90 g/l.

At the end of the 12-month study period, serum levels of total cholesterol, LDL cholesterol and triglycerides had declined markedly in both groups. Only in the group treated with EPO weekly were concentrations of serum HDL cholesterol significantly increased (P <0.001). This improvement was positively correlated with hemoglobin concentration, which increased to target levels (P <0.001 compared with baseline). A marked decrease in atherogenic LDL:HDL ratio was detected only in the cohort of patients who received EPO each week. Because renal function (measured as serum creatinine level and creatinine clearance) was more effectively preserved in this group, the authors suggest that the beneficial impact of early EPO treatment on HDL cholesterol level might contribute to amelioration of CKD progression.