BACKGROUND: Renal anemia complicated with chronic kidney disease is usually treated with erythropoiesis-stimulating agents (ESAs). However, few studies have compared the early response of hemoglobin (Hb) to different kinds of ESAs. METHODS: The effects of three types of ESAs-epoetin alfa or beta (EPO), darbepoetin alfa (DPO), and epoetin beta pegol (EPObp)-on renal anemia were followed in 416 pre-dialysis chronic kidney disease (CKD) patients. After the initial 12-week administration of ESAs, ΔHb/ESA dose/kg was calculated as an index of efficacy of each ESA. Furthermore, independent variables associated with ΔHb/ESA dose/kg (dependent variable) were determined using multiple linear regression analysis. The ten independent variables selected for analysis were: presence of diabetic nephropathy, estimated glomerular filtration rate (eGFR), Hb, albumin, iron (Fe), transferrin saturation (TSAT), ferritin, phosphate (P), intact parathyroid hormone (iPTH), and C-reactive protein. RESULTS: The efficacy of DPO and EPObp were similar and higher than EPO. TSAT was most strongly correlated with ΔHb/EPO dose/kg in all three types of ESAs. Other significant independent factors were Hb, albumin, P, iPTH, and diabetic nephropathy in the EPO group, eGFR in the DPO group, and Fe in the EPObp group. The adjusted coefficient of determination (R (2)) ranged from 0.415 to 0.520 in the three ESA groups. CONCLUSIONS: The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKD patients.
BACKGROUND:Renal anemia complicated with chronic kidney disease is usually treated with erythropoiesis-stimulating agents (ESAs). However, few studies have compared the early response of hemoglobin (Hb) to different kinds of ESAs. METHODS: The effects of three types of ESAs-epoetin alfa or beta (EPO), darbepoetin alfa (DPO), and epoetin beta pegol (EPObp)-on renal anemia were followed in 416 pre-dialysis chronic kidney disease (CKD) patients. After the initial 12-week administration of ESAs, ΔHb/ESA dose/kg was calculated as an index of efficacy of each ESA. Furthermore, independent variables associated with ΔHb/ESA dose/kg (dependent variable) were determined using multiple linear regression analysis. The ten independent variables selected for analysis were: presence of diabetic nephropathy, estimated glomerular filtration rate (eGFR), Hb, albumin, iron (Fe), transferrin saturation (TSAT), ferritin, phosphate (P), intact parathyroid hormone (iPTH), and C-reactive protein. RESULTS: The efficacy of DPO and EPObp were similar and higher than EPO. TSAT was most strongly correlated with ΔHb/EPO dose/kg in all three types of ESAs. Other significant independent factors were Hb, albumin, P, iPTH, and diabetic nephropathy in the EPO group, eGFR in the DPO group, and Fe in the EPObp group. The adjusted coefficient of determination (R (2)) ranged from 0.415 to 0.520 in the three ESA groups. CONCLUSIONS: The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKDpatients.
Entities:
Keywords:
Darbepoetin alfa; Epoetin; Epoetin beta pegol; Renal anemia; Responsiveness to ESA
Authors: Ana de Lurdes Agostinho Cabrita; Ana Pinho; Anabela Malho; Elsa Morgado; Marília Faísca; Hermínio Carrasqueira; Ana Paula Silva; Pedro Leão Neves Journal: Int Urol Nephrol Date: 2010-07-17 Impact factor: 2.370
Authors: Scott D Solomon; Hajime Uno; Eldrin F Lewis; Kai-Uwe Eckardt; Julie Lin; Emmanuel A Burdmann; Dick de Zeeuw; Peter Ivanovich; Andrew S Levey; Patrick Parfrey; Giuseppe Remuzzi; Ajay K Singh; Robert Toto; Fannie Huang; Jerome Rossert; John J V McMurray; Marc A Pfeffer Journal: N Engl J Med Date: 2010-09-16 Impact factor: 91.245
Authors: Ali Ahmed; Ahsan Husain; Thomas E Love; Giovanni Gambassi; Louis J Dell'Italia; Gary S Francis; Mihai Gheorghiade; Richard M Allman; Sreelatha Meleth; Robert C Bourge Journal: Eur Heart J Date: 2006-05-18 Impact factor: 29.983
Authors: Paul C Lee; Annapoorna S Kini; Chowdhury Ahsan; Edward Fisher; Samin K Sharma Journal: J Am Coll Cardiol Date: 2004-08-04 Impact factor: 24.094