title: Impact of Switching From Darbepoetin Alfa to Epoetin Beta Pegol on Iron Utilization and Blood Pressure in Peritoneal Dialysis Patients.
abstract: 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 Hgb 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.
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Washida
authors.affiliation: Department of Nephrology, Saitama Medical Center, Saitama, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Shinozuka
authors.affiliation: Department of Nephrology, Saiseikai Central Hospital, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hosoya
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kohkichi
authors.initials: K
authors.lastname: Morimoto
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Wakino
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
mesh_terms: D001794:Blood Pressure / Q000187:drug effects*; D000068256:Darbepoetin alfa / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004921:Erythropoietin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D017467:Receptors, Erythropoietin; D014168:Transferrin / Q000032:analysis
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D017467:Receptors, Erythropoietin; D014168:Transferrin; C508420:continuous erythropoietin receptor activator; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols; D005293:Ferritins; D007501:Iron
keywords: Blood pressure; Darbepoetin alfa; Epoetin beta pegol; Iron utilization