The effect of ferric citrate hydrate on fibroblast growth factor 23 and platelets in iron deficiency anemia, both with and without chronic kidney disease

According to a recent study, irrespective of chronic kidney disease (CKD) status, iron replacement using ferric citrate hydrate (FC) reduced high levels of C-terminal fibroblast growth factor 23 (cFGF23) and restored increased platelet (PLT) counts for individuals suffering from iron deficiency anemia (IDA). This research findings were published in the journal, Clinical and Experimental Nephrology. 
In a randomized, 24-week clinical trial, a total of seventy-three patients suffering from chronic kidney disease not requiring dialysis and CKD complicated by iron deficiency anemia with hemoglobin levels between 8.0 and 11.0 g/dL, and serum ferritin levels below 50 ng/mL for CKD and below 12 ng/mL for non-CKD, were randomly assigned in a 1:1 ratio to receive either ferric citrate hydrate-high (1000 mg: ≈ 240 mg elemental iron per day) and ferric citrate hydrate-low (500 mg: ≈ 120 mg elemental iron per day). Patients were divided into two groups: FC-low (CKD n = 21, non-CKD n = 15) and FC-high (CKD n = 21, non-CKD n = 16). Treatment was discontinued if adequate iron replacement was achieved by eight weeks.
Despite CKD status, FC increased transferrin saturation and serum ferritin, with no impact on intact FGF23 or serum phosphorus, but a decrease in cFGF23. The FC-low group showed median changes in cFGF23 from baseline to week 8 of -58.00 RU/mL in CKD and -725.00 RU/mL in non-CKD. The FC-high group had median changes of -66.00 RU/mL in CKD and -649.50 RU/mL in non-CKD. By the eighth week, FC treatment successfully normalized PLT levels in all patients who had high PLT at the beginning (>35.2 × 104/µL; FC-low: one CKD, eight non-CKD; FC-high: three CKD, eight non-CKD).
Thus, it can be concluded that iron replacement therapy with FC lowered high levels of cFGF23 and improved elevated PLT counts in individuals diagnosed with IDA, irrespective of their chronic kidney disease (CKD) status.
 

Aranesp more efficient in achieving target hemoglobin than Eprex, with less dose changes and minor complications

A recent study suggests that Aranesp Q weekly or every 2 weeks is more efficient than Eprex in achieving target Hb in hemodialysis (HD) patients. This study was published in the journal, International Urology and Nephrology.

This prospective, randomized, open-labeled study conducted for 24 weeks included 139 patients who were undergoing HD for >3 months and were >18 years of age, and on Eprex for >3 months. The patients were randomized into Aranesp group (A; n=72) and Eprex group (B; n=67). Patients in A group who were on Eprex Q TIW or BIW were converted to Aranesp Q weekly, by using the conversion factor of 200:1 and those on Eprex Q weekly were converted to Aranesp Q 2 weeks. On the other hand, B group patients continued on Eprex treatment. The primary end points of the study were percentage of patients achieving target Hb, number of dose changes in each group, and hemoglobin variability.

It was seen that target Hb was achieved in 64.8 % of the Aranesp and 59.7 % in the Eprex group. Mean number of dose changes was 1.3 and 1.9 in the Aranesp and Eprex groups, respectively. Also, the Hb variability was less frequent in the Aranesp group. Thus, it can be concluded that with less dose changes and minor vascular access complications, Aranesp Q weekly or every 2 weeks may be more efficient than Eprex in achieving target Hb in HD patients.

Darbepoetin-α effective in anemia correction, improving cardiovascular performance than epoetin-α

A recent study suggests that darbepoetin-α is effective in correcting anemia and improving cardiovascular performance in chronic kidney disease (CKD) patients compared to epoetin-α. This study was published in the journal, Cardiorenal Medicine.

This single-centre, retrospective, observational study included 100 stage IV CKD patients. They were given erythropoiesis-stimulating agents (ESA) i.e. 20 μg darbepoetin-α weekly and 2,000 IU epoetin-α thrice weekly in a 1:300 conversion ratio. This study evaluated the cardiovascular outcomes in the two groups and every 3 months, haemoglobin (Hb), C-reactive protein, hematocrit, basal echocardiograms and pro-brain natriuretic peptide (BNP) were monitored.

At the end of the study, it was observed that darbepoetin-α was significantly more effective than epoetin-α in increasing Hb levels after 3, 6, 9, and 12 months. Compared to 70% of patients treated with epoetin-α, the optimal Hb target level was reached after one year of treatment with darbepoetin-α. Cardiovascular performance after darbepoetin-α treatment significantly improved at the 6- and 12-month follow-ups.

Based on the above results, it can be concluded that darbepoetin-α may appear to be effective in correcting anemia and improving cardiovascular performance in CKD patients compared to epoetin-α.

Safety and efficacy of nalfurafine in patients with chronic kidney disease-associated pruritus undergoing hemodialysis

According to a recent study, nalfurafine effectively reduced itching of treatment-resistant chronic kidney disease-associated pruritus (CKD-aP) patients undergoing hemodialysis. This study’s results were published in the journal, Renal failure.

This phase III multicenter study included 141 patients with refractory CKD-aP, who were randomly assigned in a 2:2:1 ratio to receive 5 μg, 2.5 μg of nalfurafine or a placebo orally in a double-blind manner for 14 days. The primary endpoint of the study was the mean decrease in the mean visual analogue scale (VAS) from baseline.

At the end of the study, the difference in primary endpoint between 5 μg nalfurafine and placebo group was 11.37 mm. Adverse drug reactions (ADRs) were reportedly 49.1%, 38.6%, and 33.3% in 5μg, 2.5 μg of nalfurafine and placebo group, respectively.

From the results obtained in the above study, it can be concluded that oral nalfurafine effectively reduced itching with few significant ADRs in hemodialysis patients with refractory pruritus.