KDIGO Clinical Practice Guideline for Acute Kidney Injury
Erythropoietin

Erythropoietin

A small pilot trial evaluated the effectiveness of erythropoietin in the prevention of AKI after elective coronary artery bypass graft.²⁵⁵ Patients received either 300 U/kg of erythropoietin or saline i.v. before surgery. AKI was defined as a 50% increase in SCr levels over baseline within the first five postoperative days. Of 71 patients, 13 developed postoperative AKI: three of the 36 patients in the erythropoietin group (8%) and 10 of the 35 patients in the placebo group (29%; P = 0.035). The increase in postoperative SCr concentration and the decline in postoperative eGFR were significantly lower in the erythropoietin group than in the placebo group.

More recently, Endre et al.,²⁵⁶ performed a prospective randomized trial with erythropoietin in the primary prevention of AKI in ICU patients at risk for AKI (Suppl Table 14). As a guide for choosing the patients for treatment the urinary levels of two biomarkers, the proximal tubular brush border enzymes c-glutamyl transpeptidase and alkaline phosphatase were measured. Randomization to either placebo or two doses of erythropoietin was triggered by an increase in the biomarker concentration product to levels above 46.3. The primary outcome was the relative average SCr increase from baseline over 4–7 days. The triggering biomarker concentration product selected patients with more severe illness and at greater risk of AKI, dialysis, or death; however, the urinary marker elevations were transient. The use of the biomarkers allowed randomization within an average of 3.5 hours of a positive sample. There was no difference in the incidence of erythropoietin-specific adverse events; however, there was also no difference in the primary outcome between the placebo and treatment groups.