Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients.
BACKGROUND
Renal anemia complicated with chronic kidney disease is usually treated with erythropoiesis-stimulating agents (ESAs). However, few studies have compared the early response of hemoglobin (Hb) to different kinds of ESAs.


METHODS
The effects of three types of ESAs-epoetin alfa or beta (EPO), darbepoetin alfa (DPO), and epoetin beta pegol (EPObp)-on renal anemia were followed in 416 pre-dialysis chronic kidney disease (CKD) patients. After the initial 12-week administration of ESAs, ΔHb/ESA dose/kg was calculated as an index of efficacy of each ESA. Furthermore, independent variables associated with ΔHb/ESA dose/kg (dependent variable) were determined using multiple linear regression analysis. The ten independent variables selected for analysis were: presence of diabetic nephropathy, estimated glomerular filtration rate (eGFR), Hb, albumin, iron (Fe), transferrin saturation (TSAT), ferritin, phosphate (P), intact parathyroid hormone (iPTH), and C-reactive protein.


RESULTS
The efficacy of DPO and EPObp were similar and higher than EPO. TSAT was most strongly correlated with ΔHb/EPO dose/kg in all three types of ESAs. Other significant independent factors were Hb, albumin, P, iPTH, and diabetic nephropathy in the EPO group, eGFR in the DPO group, and Fe in the EPObp group. The adjusted coefficient of determination (R (2)) ranged from 0.415 to 0.520 in the three ESA groups.


CONCLUSIONS
The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKD patients.
Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan. kuwaharam@shuuwa-gh.or.jp.
Michio
M
Kuwahara
Department of Nephrology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Youhei
Y
Arai
Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.
Eriko
E
Takehara
Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.
Yasunori
Y
Sasaki
Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.
Tomoharu
T
Yoshimine
Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.
Keita
K
Kusaka
Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.
Satomi
S
Shikuma
Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.
Wataru
W
Akita
Department of Nephrology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Shinichi
S
Uchida
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*
D006397:Hematinics; D004921:Erythropoietin
Darbepoetin alfa; Epoetin; Epoetin beta pegol; Renal anemia; Responsiveness to ESA