title: Fixed dose of long-acting erythropoietic stimulating agents at higher frequency improves appetite, reduces inflammation and corrects anaemia in patients on haemodialysis.
abstract: Anaemia is an important issue in patients undergoing haemodialysis. We aimed to identify a better dosing schedule of a fixed monthly dose of continuous erythropoietin receptor activator (CERA) in patients with chronic kidney disease (CKD) on haemodialysis. The CERA dosing schedule included 100 μg once monthly for 2 months, 50 μg twice monthly for 2 months and then 100 μg once monthly for two months. The effectiveness was determined by comparing haematocrit, nutritional status (serum protein and albumin) and inflammatory markers (tumour necrosis factor (TNF)-α, interleukin (IL)-1, IL-6 and Hepcidin) at the beginning of the study with those at the end of the study. Forty-seven out of 67 patients completed the trial. At the end, haematocrit was significantly higher (34.51 vs 33.22%, P=.004), levels of inflammatory markers were significantly lower (TNF-α (30.71 vs 35.67 ng/mL, P=.007), IL-6 (5.12 vs 7.95 ng/mL, P=.033), hepcidin (60.39 vs 74.39 ng/mL, P=.002)), blood glucose levels were significantly lower (112.40 vs 139.02 mg/dL, P=.003) and albumin was significantly higher (4.11 vs 3.98, P=.001). Patients with a better than average response had a lower initial number of red blood cells (3.3 vs 3.6 × 10(6) /mm(3) , P=.025) and a lower IL-1 (3.8 vs 12.9 ng/mL, P=.01). They also had significantly lower blood glucose levels at the end. (91.3 vs 124.0 mg/dL, P=.03). We demonstrate that a fixed monthly dose of CERA at a twice monthly dosing schedule improves nutrition, reduces the inflammation and corrects anaemia in patients on haemodialysis. This finding may provide a new strategy for treating CKD-related anaemia.
authors.affiliation: 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.
authors.forename: Wen-Sheng
authors.initials: WS
authors.lastname: Liu
authors.affiliation: Institute of Public Health and Community Medicine Research Centre, National Yang-Ming University, Taipei, Taiwan.|Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.|Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Da-Chen
authors.initials: DC
authors.lastname: Chu
authors.affiliation: Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan.
authors.forename: Hsiang-Lin
authors.initials: HL
authors.lastname: Chan
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.affiliation: College of Medicine & Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Chih-Kuang
authors.initials: CK
authors.lastname: Liu
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Yang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.|Department of Nursing, Yuanpei University, Hsinchu, Taiwan.
authors.forename: Yen-Ting
authors.initials: YT
authors.lastname: Lai
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chih-Ching
authors.initials: CC
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D001066:Appetite / Q000187:drug effects* / Q000502:physiology; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D003692:Delayed-Action Preparations; D006397:Hematinics
keywords: anaemia; dosing strategy; erythropoietin stimulating agent; haemodialysis; inflammation; malnutrition