Darbepoetin for the anaemia of chronic kidney disease

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

“…As a result, the frequency of RBC transfusion in patients with CKD has decreased [204][205][206]. However, RBC transfusion is still required in certain conditions and will still be necessary in the future.…”

Rationale and study design of a randomized controlled trial to assess the effects of maintaining hemoglobin levels using darbepoetin alfa on prevention of development of end-stage kidney disease in non-diabetic CKD patients (PREDICT Trial)

“…A meta-analysis of the benefits and harms of darbepoetin alfa used to treat anemia in adults and children with CKD concluded that it reduced the need for blood transfusion but increased the risk of hypertension. Darbepoetin alfa had little or no effect on mortality or quality of life in adult patients with CKD stage 3-5 [8].…”

“…A meta-analysis revealed a significant increase in the risk of stroke, vascular access thrombosis, and hypertension [8]. In addition, it showed a probable increase in the risk of all-cause death, serious CV events, and end-stage renal disease.…”

“…Correction of anemia in CKD patients using erythropoiesis-stimulating agents (ESA) or iron has been investigated in randomized controlled studies, but the results are inconclusive [6][7][8][9][10][11][12][13][14][15]. Randomized controlled trials intentionally targeting Hb levels of 13 g/dL or higher, including the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial [10], the Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR) trial [11], and the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT) [12], failed to demonstrate beneficial effects and resulted in increased severe adverse events including stroke and CVD.…”

Erythropoietin corrects anaemia and reduces the risk of blood transfusion in people with chronic kidney disease, but has uncertain effects on other patient-level outcomes

“…No significant differences were observed in composite death and end-stage kidney disease (ESKD) or death and cardiovascular events. A subsequent systematic review of 32 RCTs of darbepoetin treatment reported reduced transfusion requirements but little or no effect on mortality or QOL 4. An earlier meta-analysis of 27 RCTs reported that targeting higher haemoglobin levels with ESAs in CKD patients increased stroke, hypertension and vascular access thrombosis risks, and had uncertain effects on other patient-level outcomes 2.…”