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Impact of Switching From Darbepoetin Alfa to E poetin Beta Pegol on Iron Utilization and Blood Pressure in Peritoneal Dialysis Patients
Author(s) -
Washida Naoki,
Inoue Shuji,
Kasai Takahiro,
Shinozuka Keisuke,
Hosoya Koji,
Morimoto Kohkichi,
Wakino Shu,
Hayashi Koichi,
Itoh Hiroshi
Publication year - 2015
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12306
Subject(s) - medicine , darbepoetin alfa , anemia , gastroenterology , peritoneal dialysis , erythropoietin , transferrin saturation , ferritin , hemoglobin , blood pressure , erythropoiesis , urology , surgery , iron deficiency
New erythropoiesis‐stimulating agents with a longer half‐life have been developed for the treatment of anemia in patients with end‐stage renal disease. This study evaluated the efficacy of darbepoetin alfa ( DA ) and long‐acting epoetin beta pegol (continuous erythropoietin receptor activator, CERA ) in patients on peritoneal dialysis ( PD ). Twenty‐nine patients who had undergone PD for at least 6 months and were iron replacement‐naïve and negative for inflammatory parameters were enrolled. Hemoglobin ( Hgb ) levels and blood pressure were evaluated before and after switching from DA to CERA . Percent transferrin saturation ( TSAT ), serum ferritin levels and blood pressure were also assessed. Twenty‐eight patients were subject to the analysis, excluding one patient with a decrease in H gb by ≥10%. Switching from DA to CERA did not alter Hgb levels. The doses of DA and CERA after 12 month treatment of each agent were 118.48 ± 79.63 and 89.88 ± 47.50 μg/4 weeks, respectively (conversion ratio, 1:0.76). The CERA dose administered during the final 6 months was abated, compared with that given during the initial 6 months ( P = 0.035). The frequency of CERA injection over a 12‐month period was less than that of DA (10.0 ± 3.0 vs. 16.4 ± 5.0, P < 0.01). The conversion from DA to CERA did not alter TSAT , but decreased serum ferritin levels (from 202.69 ± 132.57 to 150.15 ± 110.07 ng/mL, P = 0.012) and systolic blood pressure (from 133.8 ± 17.3 to 129.5 ± 11.3 mm Hg, P = 0.024). In PD patients, lower doses and less frequent injection of CERA are sufficient to maintain Hgb at levels similar to those achieved by DA therapy, with improved iron utilization and reduced blood pressure.