title: Effect of conversion from ESA with shorter half-life to CERA once monthly for maintaining Hb concentration in pre-dialysis CKD patients.
abstract: BACKGROUND
  The purpose of this study is to identify whether hemoglobin (Hb) concentrations can be maintained, and to investigate changes in biomarkers, when switching from erythropoietin stimulating agents (ESA) with shorter half-life to once-monthly subcutaneous methoxy polyethylene glycol-epoetin β (CERA) in pre-dialysis chronic kidney disease (CKD) patients.
  
  
  METHODS
  Pre-dialysis CKD patients (n=191) aged ≥18 years who maintained their Hb level 10-12 g/dL through use of epoetin-α, epoetin-β, or darbepoetin-α were enrolled. Hb levels and CERA dose was assessed prospectively for 24 weeks. Serum biomarkers related to coagulation, endothelial function, and iron metabolism were measured at weeks 0 and 24.
  
  
  RESULTS
  Baseline Hb concentration was 10.8±0.6 g/dL Twelve and 24 weeks after conversion, mean Hb levels were 11.9±0.9 and 11.2±0.9 g/dL, respectively. The mean monthly CERA dose required to maintain Hb levels was gradually reduced. Of total 387 dose adjustments, dose increases and decreases occurred in 35 (9.0%) and 352 (91.0%) episodes, respectively. Hb overshoot occurred in 14 (9.7%) patients. P-selectin was significantly decreased, whereas VCAM was significantly increased 24 weeks after conversion (P < 0.05). Serum soluble transferrin receptor E-selectin and prohepcidin levels were similar before and after switching to CERA (P=N-S).
  
  
  CONCLUSIONS
  Conversion from ESA with shorter half-life to subcutaneous once-monthly CERA in pre-dialysis CKD patients can efficaciously maintain Hb. The CERA dose requirement decreased significantly. The conversion ratio may need to be reduced when switching from ESA with shorter half-life to CERA. CERA may change biomarkers associated with platelet reactivity and endothelial microenvironment.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Kwon Wook
authors.initials: KW
authors.lastname: Joo
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Kang Wook
authors.initials: KW
authors.lastname: Lee
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Moon
authors.forename: Sug Kyun
authors.initials: SK
authors.lastname: Shin
authors.forename: Wooseong
authors.initials: W
authors.lastname: Huh
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Chan-Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
mesh_terms: D000068256:Darbepoetin alfa; D004334:Drug Administration Schedule; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage* / Q000031:analogs & derivatives; D005260:Female; D005500:Follow-Up Studies; D006207:Half-Life; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; C508420:continuous erythropoietin receptor activator; C103998:epoetin beta; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols; D000068817:Epoetin Alfa