Summary
A randomised pilot study to assess the effects of Epoetin beta on blood transfusion requirement and renal function in patients with critical illness/sepsis.
EPO has been used for several years to treat anaemia associated with renal failure. It has also been shown to be effective in treating anaemia in a number of other conditions (rheumatological disorders, trauma and surgery). An early pilot study in 2007/8 included two groups; one group (20 patients) undergoing CABG (received EPO as a single dose of 15,000 Units x 10 patients and 30,0000 units x 10 between 3-6 hours pre surgery). The other group were patients with critical illness and AKI (in ICU) who received EPO 2000 units x 3 daily for 7 days. This study also sought to assess safety and tolerability of EPO at the doses used. Cardiac patients were recruited according to the Cleveland Scoring system, CSS for risk assessment of patients having open heart surgery. All patients entered into the study scored 7 or more (maximum score 12). Of the 20 patients recruited, 2 patients developed AKI requiring dialysis (due to pericardial effusion), they recovered renal function within 3 days. All patients showed a good response in respect of reticulocyte response and increased urine output. Of the 10 patients with critical illness and AKI due to sepsis/inflammatory response, 8 patients recovered renal function and became dialysis independent (5 of these patients recovered renal function within 5 days post initiation of EPO therapy, 3 patients recovered within 8 days. All patients showed good response in terms of haematopoietic response in terms of reticulocytosis and had increased urine output and recovery of renal function between days 5 and 10. Two of these 10 patients died of their presenting illness (sepsis and multi organ failure. In this group the results suggested a trend that renal function was improved within 24 hours of receiving EPO 2000 units three times a day. Patients in both arms tolerated the drug well.