title: Conversion from epoetin and darbepoetin to C.E.R.A. in non-dialysis CKD patients: a multicenter Italian prospective study in nephrology practice.
abstract: BACKGROUND
  In non-dialysis patients (ND-CKD), C.E.R.A. has been extensively investigated in ESA-naïve subjects but no data are available on its efficacy after switch from other ESA.
  
  
  METHODS
  In this prospective, multicenter, open-label study lasting 24 weeks, ND-CKD patients (n = 157) receiving ESA were converted to C.E.R.A. at doses lower than recommended. Primary outcome was the prevalence of Hb target (11-12.5 g/dl).
  
  
  RESULTS
  Age was 73 ± 13 years and GFR was 26.2 ± 9.4 ml/min/1.73 m(2); male gender, diabetes and prior cardiovascular disease were 49, 33 and 19%, respectively. Doses of darbepoetin (25 ± 16 µg/week, n = 124) and epoetin (5,702 ± 3,190 IU/week, n = 33) were switched to low dose C.E.R.A. (87 ± 17 µg/month). During the study, prevalence of Hb target increased from 60% to 68% at week-24, while that of Hb < 11 g/dl declined from 32% to 16% (p < 0.001). Hb increased from 11.3 ± 0.8 at baseline to 11.7 ± 0.9 g/dl at week-24 (p = 0.01) without changes in C.E.R.A. dose. Significant predictors of Hb increase were low BMI, low Hb and longer dosing intervals before switch. These factors also predicted the risk of Hb overshooting (Hb > 12.5 g/dl) occurring in 57 patients.
  
  
  CONCLUSIONS
  In ND-CKD, conversion from other ESAs to C.E.R.A. is associated with a better anemia control induced by a greater Hb increase in patients previously treated with ESAs at extended dosing interval. This parameter should be considered when switching to long-acting ESA for its potential impact on the risk of overshooting.
authors.affiliation: Division of Nephrology at Second University of Naples-S.M.d.P. Incurabili Hospital-ASL NA1, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Pasquale
authors.initials: P
authors.lastname: Polito
authors.forename: Carlo
authors.initials: C
authors.lastname: Manno
authors.forename: Biagio R
authors.initials: BR
authors.lastname: Di Iorio
authors.forename: Domenico
authors.initials: D
authors.lastname: Santoro
authors.forename: Marina
authors.initials: M
authors.lastname: Di Luca
authors.forename: Felice
authors.initials: F
authors.lastname: Nappi
authors.forename: Sandro
authors.initials: S
authors.lastname: Feriozzi
authors.forename: Ferdinando C
authors.initials: FC
authors.lastname: Sasso
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057915:Drug Substitution; D004909:Erythrocyte Indices; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010455:Peptides; D004921:Erythropoietin; C556270:peginesatide