Conversion from Recombinant Human Erythropoietin to Once Every 4 Weeks Darbepoetin Alfa for Treatment of Renal Anemia in CAPD Patients

Background

Darbepoetin alfa is a new erythropoietic protein with a three-fold longer half-life than recombinant human erythropoietin (rHuEPO), allowing for an extended dosing interval of once every 2 weeks in patients with chronic renal failure. The objective of this study was to investigate the possibility of further extending the dose interval of this erythropoietic agent to once every 4 weeks in the treatment of renal anemia in dialysis patients.

Methods

A prospective study was carried out in 14 continuous ambulatory peritoneal dialysis (CAPD) patients stably maintained on subcutaneous rHuEPO with hemoglobin level of 10–13 g/dL. They were switched to subcutaneous darbepoetin alfa administered once every 4 weeks for a period of 24 weeks. The starting dose was 40 [.proportional]g. The dose of darbepoetin alfa was then adjusted to maintain a target hemoglobin level between 10 and 13 g/dL. When darbepoetin alfa was increased by 100%, the dosing interval was shortened to maintain the target hemoglobin. Evaluation was done during the last 4 weeks.

Results

Of the 14 patients recruited, 11 patients completed the study. Of these 11 patients, 9 (82%) successfully maintained the target hemoglobin with once every 4 weeks darbepoetin alfa. For those successful patients, the mean hemoglobin level during the evaluation period was 11.13 ± 2.04 g/dL (mean ± standard deviation), and the mean change in hemoglobin level from baseline was −1.03 g/dL (95% CI: −2.34, 0.27). The mean weekly darbepoetin alfa dose requirement during the evaluation period was 12.33 ± 4.80 [.proportional]g/week, and the mean change in weekly dose from baseline was +2.33 [.proportional]g/week (95% CI: −1.35, 6.02). No serious adverse event related to darbepoetin alfa occurred during the study.

Conclusion

Darbepoetin alfa administered once every 4 weeks effectively maintained hemoglobin level in most CAPD patients after conversion from previously stabilized rHuEPO treatment. Darbepoetin alfa is safe and well tolerated, allowing for less frequent dosing. [Hong Kong J Nephrol 2007;9(2):77–81]

Key words:  continuous ambulatory peritoneal dialysis , darbepoetin alfa , end-stage renal failure , erythropoietin , renal anemia

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