Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability

The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa. This was a multicenter, observational, retrospective study in patients aged...

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Published in:International journal of nephrology and renovascular disease 2014-01, Vol.7 (default), p.353-359
Main Authors: Arrieta, Javier, Moina, Iñigo, Molina, José, Gallardo, Isabel, Muñiz, María Luisa, Robledo, Carmen, García, Oscar, Vidaur, Fernando, Muñoz, Rosa Inés, Iribar, Izaskun, Aguirre, Román, Maza, Antonio
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Language:English
Subjects:
Aluminum
Anemia
Care and treatment
Chronic kidney failure
Clinical medicine
Comparative analysis
Darbepoetin alfa
Erythropoietin, Recombinant
Health aspects
Hemodialysis
Hemoglobin
Iron
Kidney diseases
Original Research
Patients
Peritoneal dialysis
Proteins
Risk factors
Standard deviation
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container_title International journal of nephrology and renovascular disease
container_volume 7
creator Arrieta, Javier
Moina, Iñigo
Molina, José
Gallardo, Isabel
Muñiz, María Luisa
Robledo, Carmen
García, Oscar
Vidaur, Fernando
Muñoz, Rosa Inés
Iribar, Izaskun
Aguirre, Román
Maza, Antonio
description The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa. This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline. We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months -12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P
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This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline. We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months -12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P&lt;0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P&lt;0.0001). The conversion rate was 354:1 in patients requiring high (&gt;200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses. In patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. To maintain Hb stability, a conversion rate of 300:1 seems to be appropriate for most patients receiving low doses of epoetin alfa (≤200 IU/kg/week), while 350:1 would be better for patients receiving higher doses.</description><identifier>ISSN: 1178-7058</identifier><identifier>EISSN: 1178-7058</identifier><identifier>DOI: 10.2147/IJNRD.S61895</identifier><identifier>PMID: 25336984</identifier><language>eng</language><publisher>New Zealand: Dove Medical Press Limited</publisher><subject>Aluminum ; Anemia ; Care and treatment ; Chronic kidney failure ; Clinical medicine ; Comparative analysis ; Darbepoetin alfa ; Erythropoietin, Recombinant ; Health aspects ; Hemodialysis ; Hemoglobin ; Iron ; Kidney diseases ; Original Research ; Patients ; Peritoneal dialysis ; Proteins ; Risk factors ; Standard deviation</subject><ispartof>International journal of nephrology and renovascular disease, 2014-01, Vol.7 (default), p.353-359</ispartof><rights>COPYRIGHT 2014 Dove Medical Press Limited</rights><rights>2014. This work is licensed under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Arrieta et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c576t-92774ec25fe29ea9313ef04c846c5509fd9c2dab3328fde46943380d4ef5b3e73</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2229402612/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2229402612?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25336984$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arrieta, Javier</creatorcontrib><creatorcontrib>Moina, Iñigo</creatorcontrib><creatorcontrib>Molina, José</creatorcontrib><creatorcontrib>Gallardo, Isabel</creatorcontrib><creatorcontrib>Muñiz, María Luisa</creatorcontrib><creatorcontrib>Robledo, Carmen</creatorcontrib><creatorcontrib>García, Oscar</creatorcontrib><creatorcontrib>Vidaur, Fernando</creatorcontrib><creatorcontrib>Muñoz, Rosa Inés</creatorcontrib><creatorcontrib>Iribar, Izaskun</creatorcontrib><creatorcontrib>Aguirre, Román</creatorcontrib><creatorcontrib>Maza, Antonio</creatorcontrib><title>Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability</title><title>International journal of nephrology and renovascular disease</title><addtitle>Int J Nephrol Renovasc Dis</addtitle><description>The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa. This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline. We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months -12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P&lt;0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P&lt;0.0001). The conversion rate was 354:1 in patients requiring high (&gt;200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses. In patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. 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This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline. We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months -12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P&lt;0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P&lt;0.0001). The conversion rate was 354:1 in patients requiring high (&gt;200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses. In patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. To maintain Hb stability, a conversion rate of 300:1 seems to be appropriate for most patients receiving low doses of epoetin alfa (≤200 IU/kg/week), while 350:1 would be better for patients receiving higher doses.</abstract><cop>New Zealand</cop><pub>Dove Medical Press Limited</pub><pmid>25336984</pmid><doi>10.2147/IJNRD.S61895</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source PubMed (Medline); Taylor & Francis Open Access; Publicly Available Content Database
subjects Aluminum
Anemia
Care and treatment
Chronic kidney failure
Clinical medicine
Comparative analysis
Darbepoetin alfa
Erythropoietin, Recombinant
Health aspects
Hemodialysis
Hemoglobin
Iron
Kidney diseases
Original Research
Patients
Peritoneal dialysis
Proteins
Risk factors
Standard deviation
title Switch from epoetin to darbepoetin alfa in hemodialysis: dose equivalence and hemoglobin stability
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