Comparison between short- and long-acting erythropoiesis-stimulating agents in hemodialysis patients: target hemoglobin, variability, and outcome.
OBJECTIVE
Maintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long- and short-acting erythropoietin-stimulating agents such as Aranesp and Eprex in achieving these targets.


METHODS
Randomized, prospective, open-labeled study of 24 weeks includes stable patients on HD >3 months, age >18 years, and on Eprex for >3 months. Patients were randomized into two groups: A-(Aranesp group):HD patients on Eprex Q TIW or BIW were converted to Aranesp Q weekly, by using the conversion factor of 200:1 and those on Eprex Q weekly to Aranesp Q 2 weeks; B-(Eprex group):patients continued on Eprex treatment. Hemoglobin target was set at (105-125 g/l). Primary end points were percentage of patients achieving target Hb, hemoglobin variability, and number of dose changes in each group.


RESULTS
This study consisted of 139 HD patients: 72 in the Aranesp and 67 in the Eprex-mean (SD) age 54 (16.2) years, 77 (55 %) males. About 46 % were diabetic. Target Hb achieved in 64.8 % of the Aranesp and 59.7 % in the Eprex (p = 0.006). Hb variability was less frequent in the Aranesp group (p = 0.2). Mean number of dose changes was 1.3 (0.87) in the Aranesp and 1.9 (1.2) in the Eprex (p < 0.001). There was 1 vascular access thrombosis in the Aranesp and 8 in the Eprex (p < 0.001). There was no difference in hospitalization and death number between the 2 groups.


CONCLUSIONS
Aranesp Q weekly or every 2 weeks is more efficient in achieving target Hb, with less dose changes and minor vascular access complications.
Nephrology Department, Tawam Hospital in Affiliation with Johns Hopkins Medicine, P.O. Box 15258, Al Ain, United Arab Emirates, bassambernieh@hotmail.com.
Bassam
B
Bernieh
Samra
S
Abouchacra
Yousef
Y
Boobes
Mohammad R
MR
Al Hakim
Nico
N
Nagelkerke
Ahmad
A
Chaaban
Mohamad
M
Ahmed
Qutaiba
Q
Hussain
Hanan El
HE
Jack
Faiz
F
Abayechi
Imran
I
Khan
Nicole
N
Gebran
D000328:Adult; D000368:Aged; D000068256:Darbepoetin alfa; D003692:Delayed-Action Preparations; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D005260:Female; D006397:Hematinics / Q000008:administration & dosage* / Q000191:economics; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000188:drug therapy* / Q000628:therapy; D016896:Treatment Outcome
D003692:Delayed-Action Preparations; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa