Comparison between short- and long-acting erythropoiesis-stimulating agents in hemodialysis patients: target hemoglobin, variability, and outcome

Abstract

PurposeMaintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long- and short-acting erythropoietin-stimulating agents such as Aranesp and Eprex in achieving these targets.MethodsRandomized, prospective, open-labeled study of 24 weeks includes stable patients on HD >3 months, age >18 years, and on Eprex for >3 months. Patients were randomized into two groups: A-(Aranesp group):HD patients on Eprex Q TIW or BIW were converted to Aranesp Q weekly, by using the conversion factor of 200:1 and those on Eprex Q weekly to Aranesp Q 2 weeks; B-(Eprex group):patients continued on Eprex treatment. Hemoglobin target was set at (105–125 g/l). Primary end points were percentage of patients achieving target Hb, hemoglobin variability, and number of dose changes in each group.ResultsThis study consisted of 139 HD patients: 72 in the Aranesp and 67 in the Eprex—mean (SD) age 54 (16.2) years, 77 (55 %) males. About 46 % were diabetic. Target Hb achieved in 64.8 % of the Aranesp and 59.7 % in the Eprex (p = 0.006). Hb variability was less frequent in the Aranesp group (p = 0.2). Mean number of dose changes was 1.3 (0.87) in the Aranesp and 1.9 (1.2) in the Eprex (p < 0.001). There was 1 vascular access thrombosis in the Aranesp and 8 in the Eprex (p < 0.001). There was no difference in hospitalization and death number between the 2 groups.ConclusionsAranesp Q weekly or every 2 weeks is more efficient in achieving target Hb, with less dose changes and minor vascular access complications.

Fixed dose of long‐acting erythropoietic stimulating agents at higher frequency improves appetite, reduces inflammation and corrects anaemia in patients on haemodialysis

“…Our results are similar to those reported by Bernieh et al, who found that weekly or twice monthly administration of Aranesp Q, a long-acting ESA, was more efficient in achieving target Hb with less dose changes and fewer vascular access complications than Eprex Q, a short-acting ESA, in patients on HD. 31 Another study showed that long-acting ESAs such as CERA may help maintain higher Hb in predialysis patients with CKD than shorter-acting ESAs, such as recombinant human erythropoietin (rHuEPO). 32 It has also been shown that short-acting ESAs are associated with Hb instability.…”

Effect of dialysis dose and membrane flux on hemoglobin cycling in hemodialysis patients

“…Maintaining Hb levels within a narrow target range in dialysis patients is notoriously challenging due to the high degree of Hb variability observed in dialysis populations. 22 The National Kidney Foundation Kidney Disease Outcome Quality Initiative recommends targeting Hb between 11.0 and 12.0 g/dL, but Hb levels change over time, suggesting that only 30% of patients fall within this range at any point in time. 23 Large population-based studies of Hb variability performed in hemodialysis and chronic kidney disease patients have revealed an association with decreased survival, comorbidity, and hospitalizations.…”

“…Maintaining Hb levels within a narrow target range in dialysis patients is notoriously challenging due to the high degree of Hb variability observed in dialysis populations . The National Kidney Foundation Kidney Disease Outcome Quality Initiative recommends targeting Hb between 11.0 and 12.0 g/dL, but Hb levels change over time, suggesting that only 30% of patients fall within this range at any point in time .…”

Comparison between Long- and Short-Acting Erythropoiesis-Stimulating Agents in the Period Required for Haemoglobin Stabilisation in Treatment of Anaemia in Patients with Chronic Kidney Disease

“…Therapeutic efficacy was assessed based on laboratory test values obtained in the period between the initiation of administration and the efficacy assessment. ESA doses by weight were converted to a standard unit based on previous reports 8,9,13,14) and information in the package inserts, as follows: darbepoetin 15 µg, 3000 IU; 20 µg, 4500 IU; 30 µg, 6000 IU; 40 µg, 9000 IU; 50 µg, 10500 IU; 60 µg, 12000 IU; 80 µg, 18000 IU; 100 µg, 21000 IU; 120 µg, 24000 IU; and 180 µg, 36000 IU. Doses of epoetin beta pegol were converted linearly as 250 IU/µg.…”

“…Studies on short-and long-acting ESAs (S-ESAs and L-ESAs, respectively) are dominated by investigations of doses when switching formulations [3][4][5][6][7] and comparative studies of the effect on Hb variability 8,9) ; no studies comparing their effect on the period until the Hb level is stabilised within the reference range are available. This is probably because a sufficient number of patients have not been available to conduct comparative studies; while S-ESAs have a long history of clinical use since the 1990s, L-ESAs have been developed only recently.…”