Hong Kong Journal of Nephrology
Volume 9, Issue 2 , Pages 77-81, October 2007

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

Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China

Article Outline

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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References 

  1. Levin A , Thompson CR , Ethier J , Carlisle EJ , Tobe S , Mendelssohn D , et al.   Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin . Am J Kidney Dis . 1999;34:125–134
  2. Harnett JD , Foley RN , Kent GM , Barre PE , Murray D , Parfrey PS . Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors . Kidney Int . 1995;47:884–890
  3. Wolcott DL , Marsh JT , La Rue A , Carr C , Nissenson AR . Recombinant human erythropoietin treatment may improve quality of life and cognitive function in chronic hemodialysis patients . Am J Kidney Dis . 1989;14:478–485
  4. Evans RW , Rader B , Manninen DL , Cooperative Multicenter EPO Clinical Trial Group  . The quality of life of hemodialysis recipients treated with recombinant human erythropoietin . JAMA . 1990;263:825–830
  5. Al-Ahmad A , Rand WM , Manjunath G , Konstam MA , Salem DN , Levey AS , et al.   Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction . J Am Coll Cardiol . 2001;38:955–962
  6. Winearls CG , Oliver DO , Pippard MJ , Reid C , Downing MR , Cotes PM . Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis . Lancet . 1986;2:1175–1178
  7. Eschbach JW , Egrie JC , Downing WR , Browne JK , Adamson JW . Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial . N Engl J Med . 1987;316:73–78
  8. Egrie J , Browne JK . Development and characterization of novel erythropoiesis stimulating protein (NESP) . Nephrol Dial Transplant . 2001;16(Suppl 3):3–13
  9. MacDougall IC , Gray SJ , Elston O , Breen C , Jenkins B , Browne J , et al.   Pharmacokinetics of novel erythropoiesis stimulating protein compared with epoetin alfa in dialysis patients . J Am Soc Nephrol . 1999;10:2392–2395
  10. Vanrenterghem Y, Barany P, Mann JF, Kerr PG, Wilson J, Baker NF, et al  Randomized trial of darbepoetin alfa for treatment of renal anemia at a reduced dose frequency compared with rHuEPO in dialysis patients . Kidney Int . 2002;62:2167–2175
  11. Locatelli F, Olivares J, Walker R, Wilkie M, Jenkins B, Dewey C, et al  Novel erythropoiesis stimulating protein for treatment of anemia in chronic renal insufficiency . Kidney Int . 2001;60:741–747
  12. Nissenson AR , Swan SK , Lindberg JS , Soroka SD , Beatey R , Wang C , et al.   Randomized, controlled trial of darbepoetin alfa for the treatment of anemia in hemodialysis patients . Am J Kidney Dis . 2002;40:110–118
  13. MacDougall IC , Matcham J , Gray SJ , NESP 960245/246 Study Group  . Correction of anaemia with darbepoetin alfa in patients with chronic kidney disease receiving dialysis . Nephrol Dial Transplant . 2003;18:576–581
  14. Locatelli F , Canaud B , Giacardy F , Martin-Malo A , Baker N , Wilson J . Treatment of anaemia in dialysis patients with unit dosing of darbepoetin alfa at a reduced dose frequency relative to recombinant human erythropoietin (rHuEpo) . Nephrol Dial Transplant . 2003;18:362–369
  15. Brunkhorst R, Bommer J, Braun J, Haag-Weber M, Gill C, Wagner J, et al  Darbepoetin alfa effectively maintains haemoglobin concentrations at extended dose intervals relative to intravenous or subcutaneous recombinant human erythropoietin in dialysis patients . Nephrol Dial Transplant . 2004;19:1224–1230
  16. Hertel J , Locay H , Scarlata D , Jackson L , Prathikanti R , Audhya P . Darbepoetin alfa administered every other week maintains hemoglobin levels over 52 weeks in patients with chronic kidney disease converting from once-weekly recombinant human erythropoietin: results from simplify the treatment of anemia with Aranesp (STAAR) . Am J Nephrol . 2006;26:149–156
  17. Carrera F , Oliveira L , Maia P , Mendes T , Ferreira C . The efficacy of intravenous darbepoetin alfa administered once every 2 weeks in chronic kidney disease patients on haemodialysis . Nephrol Dial Transplant . 2006;21:2846–2850
  18. Jadoul M , Vanrenterghem Y , Foret M , Walker R , Gray SJ , Darbepoetin Alfa 20000144 Study Group  . Darbepoetin alfa administered once monthly maintains haemoglobin levels in stable dialysis patients . Nephrol Dial Transplant . 2004;19:898–903
  19. Theodoridis M , Passadakis P , Kriki P , Panagoutsos S , Yannatos E , Kantartzi K , et al.   Efficient monthly subcutaneous administration of darbepoetin in stable CAPD patients . Perit Dial Int . 2005;25:564–569
  20. Aljama P, Bommer J, Canaud B, Carrera F, Eckardt KU, Horl WH, et al  Practical guidelines for the use of NESP in treating renal anaemia . Nephrol Dial Transplant . 2001;16(Suppl 3):22–28

PII: S1561-5413(08)60004-6

doi:10.1016/S1561-5413(08)60004-6

Hong Kong Journal of Nephrology
Volume 9, Issue 2 , Pages 77-81, October 2007

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