title: Treatment of renal anaemia with erythropoiesis-stimulating agents in predialysis chronic kidney disease patients: Haemoglobin profile during the 6 months before initiation of dialysis.
abstract: OBJECTIVE
  Erythropoiesis-stimulating agents (ESAs) are all effective for renal anaemia in patients with chronic kidney disease (CKD). However, it was reported that the haemoglobin (Hb) concentration decreases to 8.4 g/dL during the initial phase of dialysis despite treatment with recombinant human erythropoietin (rHuEPO). This study compared Hb at the initiation of dialysis among patients treated with three different ESAs (rHuEPO, darbepoetin alfa [DA], and a continuous erythropoietin receptor activator [CERA]).
  
  
  METHODS
  The subjects were 82 CKD patients who started dialysis at Kawashima Hospital between 1 January 2009 and 28 February 2015 and who received only one kind of ESA for at least 6 months before initiation of dialysis. Baseline characteristics and laboratory data at initiation of dialysis were compared among the three groups. Then changes of the Hb, ESA dose, and erythropoiesis resistance index were assessed over time during the 6 months before initiation of dialysis. Differences of Hb at the initiation of dialysis were also assessed.
  
  
  RESULTS
  Among the 82 patients, 36 received rHuEPO, 13 received DA, and 33 received CERA. Baseline characteristics and laboratory data of the patients showed no significant differences among the three groups. The monthly Hb decreased gradually during the 6-month period before initiation of dialysis in all three groups. Hb was significantly higher in the CERA group than the rHuEPO group at the initiation of dialysis.
  
  
  CONCLUSIONS
  Long-acting ESAs may be more useful for predialysis patients with CKD because they do not attend hospital frequently, unlike haemodialysis patients.
authors.affiliation: Kamojima-Kawashima Clinic, Tokushima, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kawahara
authors.affiliation: Kawashima Hospital, Tokushima, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Minakuchi
authors.affiliation: Kawashima Hospital, Tokushima, Japan.
authors.forename: Narushi
authors.initials: N
authors.lastname: Yokota
authors.affiliation: Kawashima Hospital, Tokushima, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Suekane
authors.affiliation: Kawashima Dialysis Clinic, Tokushima, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsuchida
authors.affiliation: Kawashima Hospital, Tokushima, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Kawashima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D000068256:Darbepoetin alfa / Q000627:therapeutic use*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D013997:Time Factors
chemical_list: C554270:EPO protein, human; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; C508420:continuous erythropoietin receptor activator; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols
keywords: chronic kidney disease; continuous erythropoietin receptor activator; erythropoiesis-stimulating agent; initiation of dialysis; renal anaemia