Shift from darbepoetin-α to continuous erythropoietin receptor activator decreases serum aluminium concentration in patients on hemodialysis.
OBJECTIVE
The response of erythropoietic stimulating agents (ESA) in uremic patients may be associated with the changes of biochemical parameters, metal elements and inflammation status during the shift from one ESA to another.


METHODS
We compared changes in above mentioned factors after switching from darbepoetin-α (DPO) 20μg weekly for 10 weeks to continuous erythropoietin receptor activator (CERA) 100μg monthly for 10 weeks in uremic patients on hemodialysis. The haematocrit (Hct), metal elements and inflammation status are the primary outcome. Subjects included 54 patients without transfusion or bleeding or additional ESAs. Responders (IR, n=36) were defined as patients with an increase in Hct after the swtich.


RESULTS
Although there was no significant difference in overall mean Hct after the switch (p=0.135), there are significantly greater mean number of red blood cells (RBC) (p=0.006), higher platelet numbers (p=0.001), larger RBCs (p=0.017) and higher creatinine (p=0.04) and total cholesterol (T-CHOL) (p=0.003) levels. Mean overall aluminium (Al) level decreased significantly (p=0.001). C-reactive protein (CRP) also decreased (p=0.016). The overall LDH increased (p=0.049) and potassium decreased significantly (p=0.036), which indicating active erythropoiesis. The calcium (Ca) level was significantly higher (p=0.034) and phosphate was significantly lower (p=0.028) after the shift. Although there was no significant increase in overall levels of parathyroid hormone (PTH) after the shift (p=0.061), but the pre-shift and post-shift PTH level was significantly higher in IRs than in non-IRs (p=0.003 and p=0.027, respectively). IRs had a significantly lower initial T-CHOL (p=0.03) and initial CRP (p=0.012) than non-responders, which may be related to lower inflammation.


CONCLUSIONS
We found the shift from DPO to CERA results in lower Al levels, a reduced inflammatory response, and an increase in RBC number and PTH level in uremic patients on hemodialysis.
Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhong-Xing Branch, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan; College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan.
Wen-Sheng
WS
Liu
Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
Hsiang-Lin
HL
Chan
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Nursing, Yuanpei University, Hsinchu, Taiwan.
Yen-Ting
YT
Lai
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
Ya-Hsu
YH
Yang
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Hao-Wei
HW
Teng
College of Medicine & Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan.
Chih-Kuang
CK
Liu
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Szu-Yuan
SY
Li
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Chih-Yu
CY
Yang
Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: tyliu2@ym.edu.tw.
Tsung-Yun
TY
Liu
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: lincc2@vghtpe.gov.tw.
Chih-Ching
CC
Lin
D000368:Aged; D000369:Aged, 80 and over; D000535:Aluminum / Q000097:blood*; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D000068256:Darbepoetin alfa / Q000494:pharmacology / Q000627:therapeutic use*; D004906:Erythrocyte Count; D004921:Erythropoietin / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000494:pharmacology / Q000627:therapeutic use*; D006435:Renal Dialysis; D014511:Uremia / Q000097:blood
D006397:Hematinics; D010281:Parathyroid Hormone; C508420:continuous erythropoietin receptor activator; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols; D002784:Cholesterol; D003404:Creatinine; D000535:Aluminum
Aluminium; Continuous erythropoietin receptor activator; Erythropoietin stimulating agent; Hemodialysis; Parathyroid hormone