Anemia Treatment by Erythropoiesis-stimulating Agents during the 6 months before Initiation of Hemodialysis: Comparison between Darbepoetin Alfa and Continuous Erythropoietin Receptor Activator [Published online in advanced , by J-STAGE]

[Advanced Published online The Keio Journal of Medicine, by J-STAGE]
<Title:> Anemia Treatment by Erythropoiesis-stimulating Agents during the 6 months before Initiation of Hemodialysis: Comparison between Darbepoetin Alfa and Continuous Erythropoietin Receptor Activator
<Author(s):> Tadashi Yoshida, Matsuhiko Hayashi
<Corresponding author E-Mill:> tayoshida-npr(at)umin.ac.jp
<Abstract:> Anemia in chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is treated by long-acting erythropoiesis-stimulating agents (ESA). Although results of previous studies showed that the hemoglobin level could not be maintained at initiation of dialysis in CKD patients treated with recombinant human erythropoietin, it remains undetermined if long-acting ESA are effective to prevent the progression of anemia at initiation of dialysis. In the present study, hemoglobin levels in 40 CKD patients treated with darbepoetin alfa (DA) and 15 CKD patients treated with a continuous erythropoietin receptor activator (CERA) were retrospectively compared during the 6 months period prior to initiation of dialysis. Results showed that DA and CERA, respectively, maintained hemoglobin levels around 10 g/dL from 6 months to 1 month before dialysis. However, hemoglobin levels at initiation of dialysis were significantly decreased to 9.1 ± 1.2 g/dL in DA group and 9.0 ± 1.0 g/dL in CERA group, respectively. Although total doses of ESA used for 6 months were similar between two groups, DA-treated CKD patients received subcutaneous injections more frequently than patients treated with CERA. These results suggest that CKD patients are needed to receive more intense ESA therapy to prevent a decline in hemoglobin levels at initiation of dialysis, even under the use of long-acting ESA, and also raise a possibility that CERA is more useful than DA to reduce the number of injections during the pre-dialysis period.
<Keywords:> anemia, end-stage kidney disease, erythropoietin, hemodialysis, hemoglobin
<URL:> https://www.jstage.jst.go.jp/article/kjm/advpub/0/advpub_2016-0009-OA/_html