The immunosuppressant drug mycophenolate mofetil may be a better therapy to treat lupus nephritis then the more commonly used cancer drug cyclophosphamide, which suppresses the immune system but also causes hair loss, nausea, vomiting, and infertility, according to a study in the May 2009 issue of the Journal of the American Society of Nephrology.

Mycophenolate mofetil, an oral drug, is rarely used to treat lupus nephritis, but recent studies suggest that it may offer advantages over intravenous cyclophosphamide. To test this hypothesis, Neil Solomons, MD, from Aspreva Pharmaceuticals Corporation, along with other researchers recruited 370 patients with lupus nephritis from 88 centers in 20 countries. Patients received either cyclophosphamide or mycophenolate mofetil for 24 weeks.

By the end of the treatment schedule, the investigators did not detect a significantly different response rate between the two groups of patients: 104 out of 185 (56.2%) patients responded to mycophenolate mofetil compared with 98 of 185 (53%) to cyclophosphamide. There were nine deaths in the mycophenolate mofetil group and five in the cyclophosphamide group.

Researchers noted important differences across racial and ethnic groups, with more high-risk, non-white, non-Asian patients responding better to mycophenolate mofetil than to cyclophosphamide. Also, some lupus nephritis patients may prefer mycophenolate mofetil therapy since it does not affect fertility.

Anemia treatment improves heart structure, quality of life in CKD patients

In chronic kidney disease patients, different levels of anemia treatment have a beneficial effect on the heart and can improve quality of life, according to a pair of studies appearing in the April 2009 issue of the Clinical Journal of the American Society of Nephrology. The findings indicate that different levels of treatment may be warranted for different patients.

Patrick Parfrey, MD, from the Memorial University of Newfoundland, and colleagues examined the effects of different levels of anemia treatment on heart structure and quality of life in chronic kidney disease patients. The first study was a systematic review of published data on the effects of anemia on the heart. By analyzing 15 available studies involving 1,731 patients with kidney disease, the investigators found that partial correction of severe anemia with erythropoietin improved heart structure, but fully correcting anemia provided no additional benefit.

The second study assessed whether normalization of hemoglobin improves quality of life in kidney disease patients. In a randomized trial performed in Canada and Europe, Parfrey and his team enrolled 596 relatively healthy patients starting dialysis. The researchers found that patients experienced less fatigue when they were treated with erythropoietin to reach a normal hemoglobin level compared with patients who were treated to achieve only partial correction of anemia.

New Medicare policy may pose risks to black kidney patients

A change in Medicare reimbursement policy to a bundled payment could make it more difficult for black Americans with kidney disease to access dialysis services, suggests a study in an upcoming issue of the Journal of the American Society of Nephrology. “The change in payment policy may disadvantage a substantial group of dialysis patients,” Areef Ishani, MD, of the University of Minnesota said.

Black dialysis patients have more problems with anemia than white patients and thus may require more treatment with costly erythropoiesis stimulating agents (ESAs) to raise hemoglobin levels, the researchers speculated. An analysis of 12,000 patients starting dialysis during 2006, the researchers confirmed that black patients had lower initial hemoglobin levels when starting hemodialysis compared to white patients. Also, the average required dose of ESAs over the first two months on dialysis was 11% higher in black patients. Since dialysis centers will no longer be reimbursed for the higher ESA doses, the researchers are concerned that the new policy could create a “financial disincentive” to accept black Americans.

This study appears online at the http:///jasn.asnjournals.org.