ArticleClinical and experimental nephrology2026
Changes in mean corpuscular volume after erythropoiesis-stimulating agent treatment are associated with renal outcomes in non-dialysis-dependent chronic kidney disease.
Article in Clinical and experimental nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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7 authors.
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Abstract
backgroundMean corpuscular volume (MCV) is routinely measured in patients with chronic kidney disease (CKD) and anemia; however, its prognostic significance, particularly in the context of erythropoiesis-stimulating agent (ESA) therapy, remains unclear.
methodsWe conducted a post hoc analysis of the BRIGHTEN study, a multicenter, prospective trial that enrolled 1219 ESA-naïve patients with non-dialysis-dependent CKD who initiated darbepoetin alfa. Patients were categorized based on changes in MCV from baseline to week 16 as either increased or decreased. The primary outcome was renal function decline, defined as the initiation of dialysis, kidney transplantation, ≥ 50% reduction in estimated glomerular filtration rate (eGFR), or an eGFR ≤ 6 mL/min/1.73 m
resultsMCV decreased in 778 (63.8%) patients during the study period. Changes in MCV were not correlated with baseline MCV values or ESA responsiveness. Over a mean follow-up of 2.46 ± 0.78 years, renal function decline occurred in 304 (39.1%) and 140 (31.7%) patients in the decreased and increased MCV groups, respectively. After adjusting for age, sex, baseline eGFR, albumin, high-sensitivity CRP, proteinuria, ferritin, transferrin saturation and ESA responsiveness, increased MCV remained independently associated with a reduced risk of renal function decline (adjusted hazard ratio 0.67; 95% confidence interval 0.53-0.85; p < 0.001).
conclusionIn ESA-naïve patients with non-dialysis-dependent CKD, an increase in MCV following ESA treatment was associated with a significantly lower risk of renal function decline. Monitoring MCV dynamics may serve as a simple, adjunctive tool for risk stratification and individualized CKD management.
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