Comparing the efficacy of continuous erythropoietin receptor activator and darbepoetin Alfa treatments in Japanese patients with chronic kidney disease during the predialysis period: A propensity‐matched analysis

Koibuchi, Kiyoto; Miyagi, Moriatsu; Arai, Taichi; Aoki, Toshiyuki; Aikawa, Atsushi; Sakai, Ken

doi:10.1111/nep.12641

Cited by 10 publications

(11 citation statements)

References 27 publications

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“…5 Changes in hemoglobin (Hb) levels 1 year after initiation in the three groups according to the tertile of Hb levels and association between at initiation and 1 year after initiation. There were no significant differences in Hb at 1 year after initiation between the three groups, and there was no significant correlation between Hb at initiation and 1 year after initiation also reported the same correlation between them [9]. In our patients, there was a significant negative relationship between Hb and CTR at initiation.…”

Section: Discussionmentioning

confidence: 46%

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

et al. 2018

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Background: The management of renal anemia in the pre-dialysis period has been remarkably improved by longacting erythropoiesis-stimulating agents (ESA). However, many incident dialysis patients cannot achieve target hemoglobin (Hb) levels (> 10 g/dL) and sometimes require blood transfusions. Anemia at the time of dialysis initiation is reportedly correlated with cardiomegaly and early cardiovascular events. Here, we investigated whether this V-shaped depression in Hb level at dialysis initiation adversely affects short-term prognosis. Methods: The medical charts of 166 patients who underwent initial dialysis were retrospectively reviewed for Hb level, ESA treatment status, dry weight (DW), cardiothoracic rate (CTR), and brain natriuretic peptide (BNP) level at dialysis initiation and 1 year later. Patients were subdivided into three groups according to the tertile of Hb levels. The risk of mortality within 1 year after initiation was analyzed using multivariable-adjusted Cox proportional hazard model. Result: Mean Hb level at initiation was 8.6 ± 1.3 g/dL despite the administration of sufficient ESA. After initiation, Hb levels rapidly increased and the Hb time course showed a V-shape with the bottom at initiation. Hb level, CTR, and log BNP showed a significant negative correlation. The Hb level and CTR 1 year after initiation did not correlate with Hb levels at initiation. Lower Hb levels at initiation as a V-shaped depression do not adversely affect 1-year mortality rate by multivariable-adjusted Cox proportional hazard model. Conclusion: Hb level around dialysis initiation showed a V-shaped depression despite ESA use. Our findings suggest that the V-shaped Hb depression at initiation does not affect short-term prognosis.

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Section: Discussionmentioning

confidence: 46%

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

et al. 2018

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“…Indeed, some previous studies used a dose conversion ratio of DA:CERA =1:0.93 for non-dialysis CKD patients, 13 whereas others used a ratio of 1:1. 23,24 We used a ratio of 1:1; however, even if a conversion ratio of 1:0.93 had been adopted, the conclusions of the present study would have remained the same.…”

Section: Discussionmentioning

confidence: 56%

“…23,24 Results of both of these studies showed a decline in Hb levels at the initiation of dialysis in CKD patients treated with epoetin, DA, or CERA. Each of these ESAs evidently failed to maintain target Hb levels at the initiation of dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to our present study, an advantage of the other two studies was that they analyzed larger numbers of CKD patients. However, a disadvantage of these studies was that they enrolled CKD patients who started dialysis from 2007 to 2014 in one study 23 and from 2009 to 2015 in the other study. 24 During these relatively long periods, guideline had been revised, 9 and many articles were published that may have influenced the decisions of nephrologists regarding the choice of ESA therapy.…”

Section: Discussionmentioning

confidence: 99%

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Anemia Treatment by Erythropoiesis-stimulating Agents during the 6 Months before the Initiation of Hemodialysis: Comparison of Darbepoetin Alfa and Continuous Erythropoietin Receptor Activator

Yoshida

Hayashi

2016

Keio J. Med.

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Anemia in chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is treated by long-acting erythropoiesis-stimulating agents (ESAs). Although the results of previous studies haveshown that hemoglobin levels could not be maintained at the initiation of dialysis in CKD patients treated with recombinant human erythropoietin, it remains undetermined whether long-acting ESAs are effective in preventing the progression of anemia at the 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 before the initiation of dialysis. Results showed that DA and CERA both maintained hemoglobin levels at around 10 g/dL from 6 months to 1 month before dialysis. However, hemoglobin levels at the initiation of dialysis significantly decreased to 9.1 ± 1.2 g/dL in the DA group and to 9.0 ± 1.0 g/dL in the CERA group. Although the total doses of ESAs used during the 6-month period were similar between the two groups, DA-treated CKD patients received subcutaneous injections more frequently than did patients treated with CERA. These results suggest that CKD patients require more intense ESA therapy to prevent a decline in hemoglobin levels at the initiation of dialysis, including those treated with long-acting ESAs. The results also raise the possibility that CERA is more useful than DA for reducing the number of injections during the pre-dialysis period.

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“…One study concluded that CERA could be more effective for correction of anemia in pre-dialysis patients. 22 The results of another study conducted in predialysis patients suggested no significant difference in the effects in regards to achievement of target hemoglobin levels in both groups ( Compliance is an important factor that determines the success of treatment and in this regards, patient's preference is considered as one of the important factors. Medicines which are preferred by the patients are more likely to be taken by them for longer period.…”

Section: Efficacy In Pre-dialysis Patientsmentioning

confidence: 99%

Darbepoetin alfa: review in the management of anemia in patients with chronic kidney disease

Barkate

Kothari

Patel

et al. 2017

Int J Basic Clin Pharmacol

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Chronic kidney disease (CKD) is a significant clinical problem across the world including India. The SEEK (Screening and Early Evaluation of Kidney Disease) study from India reported the prevalence of CKD as 17.2%. Diabetic nephropathy, undetermined etiology, chronic glomerulonephritis and hypertensive nephrosclerosis are the common causes of CKD in India. Rising rates of diabetes and hypertension, late presentation of patients to nephrologists and limited number of nephrologists in India adds to the concerns related to management of CKD. Considering the pathophysiology of CKD, anemia is almost an inevitable complication in these patients. Untreated anemia significantly contributes to the morbidity and mortality associated with CKD. Early recognition, timely management with appropriate therapy helps to reduce the complications of anemia. Erythropoiesis-stimulating agents (ESAs) are one of the important measures for correction of anemia in CKD patients. Darbepoetin, an ESA is a valuable therapeutic option for the treatment of anemia in CKD patients and has played a vital role in enhancing anemia management. In this article we reviewed the efficacy and safety data along with key benefits and place of darbepoetin alfa in the management of anemia in CKD patients.

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Comparing the efficacy of continuous erythropoietin receptor activator and darbepoetin Alfa treatments in Japanese patients with chronic kidney disease during the predialysis period: A propensity‐matched analysis

Abstract: Our study showed that CERA may be more effective than DA for management of anaemia during the predialysis period in CKD patients.

Cited by 10 publications

References 27 publications

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

Anemia Treatment by Erythropoiesis-stimulating Agents during the 6 Months before the Initiation of Hemodialysis: Comparison of Darbepoetin Alfa and Continuous Erythropoietin Receptor Activator

Darbepoetin alfa: review in the management of anemia in patients with chronic kidney disease

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