A recent study suggests that darbepoetin alfa (DA) acts as an effective treatment for anaemia in chronic kidney disease (CKD) patients not on dialysis (NoD) when administered once biweekly (Q2W) or weekly (QM). The results of this study were published in the journal, Nephrology, dialysis, transplantation.

The EXTEND study was an observational cohort study of extended dosing regimens of DA that included data obtained from 4278 patients. Data included haemoglobin levels and erythropoiesis-stimulating agent (ESA) dosing that were collected 6 months before and 12 months after DA initiation.

At the end of the study, it was seen that patients receiving ESA treatment before DA Q2W/QM initiation had a mean Hb level of 11.9 g/dL at initiation and 11.6 g/dL at Months 10-12. The mean ESA dose was 22 μg/week before initiation, 16 μg/week at initiation and 16 μg/week at Month 12. Hb levels increased from 10.3 g/dL at initiation to 11.7 g/dL at Months 4-6 in ESA-naive patients. The Hb levels were maintained at a mean level of 11.7 g/dL at Months 10-12, with mean ESA dose of 16 μg/week at initiation and 16 μg/week at Month 12.

From the above results, it can be concluded that DA Q2W/QM may be an effective treatment of anaemia in the general CKD-NoD patient population, without the need for a dose increase in patients switching from a previous ESA regimen.

A recent study suggests the effect of switching from erythropoiesis-stimulating agent (ESA) treatment from darbepoetin alfa (DA) to methoxy polyethylene glycol-epoetin beta (PEG-Epo) in treating anemia associated with chronic kidney disease (CKD). This study was published in the journal, Advances in Therapy.

The AFFIRM study was a retrospective, multi-site, observational study that included 206 patients who had received hemodialysis for ≥ 12 months and DA for ≥ 7 months. The dose conversion ratio (DCR) was calculated for patients with hemoglobin level (Hb) and ESA data for the pre-switch evaluation period (months 1 and 2) and post-switch EP (months 6 and 7). Red blood cell transfusions during both evaluation periods were noted.

The results showed a geometric mean DCR of 1.17. DCR showed a decrease with increasing pre-switch DA dose. The geometric mean weekly ESA doses in the pre-switch and post-switch EP were 24.1 μg DA and 28.6 μg PEG-Epo, respectively. Mean Hb in the pre-switch EP and post-switch EP were found to be 11.5 g/dL and 11.4 g/dL, respectively. Overall, 16 transfusions and 34 units were transfused in the pre-switch EP whereas 48 transfusions and 95 units were transfused in the post-switch EP.

It may be concluded that in hemodialysis patients switched from DA to PEG-Epo, the DCR was 1.17 and 1.21. Thus, the number of transfusions and units transfused increased three-fold times from the pre to post-switch period.

A recent study found that estimated glomerular filtration rate (eGFR) can replace measured GFR (mGFR) in partial nephrectomy (PN) trials as it helps reduce cost and patient burden. This study was published in the journal, BJU International.

This post hoc analysis of the renal hypothermia trial included 183 patients who underwent mGFR with diethylenetriaminepentaacetic acid (DTPA) plasma clearance preoperatively and 1-year post PN. Using the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equations incorporating age and sex, with and without race: 2009 eGFRcr (ASR) and 2009 eGFRcr (AS), and 2021 eGFRcr (AS), the 2021 equation that only considers age and sex; the eGFR was calculated.  Performance was evaluated on the basis of median bias, precision, and accuracy.

It was observed that the pre- and postoperative median bias and precision were similar between the 2009 eGFRcr (ASR) and 2009 eGFRcr (AS).  Bias and precision were worse for 2021 eGFRcr (AS). Similarly, pre- and postoperative accuracy was >90% for the 2009 eGFRcr (ASR) and 2009 eGFRcr (AS) equations while accuracy was 78.6% preoperatively and 66.5% postoperatively for 2021 eGFRcr (AS).[SB1] 

From the above results, it can be concluded that 2009 eGFRcr (AS) can accurately estimate GFR in PN trials and may replace mGFR to reduce cost and patient burden.

A recent study suggests that once monthly dosing of darbepoetin alfa in clinically stable dialysis patients with chronic renal failure (CRF), resulted in effective maintenance of haemoglobin. This study was published in the journal of Nephrology, dialysis, transplantation.

This study was carried out among 54 patients, who received stable darbepoetin alfa therapy once every 2 weeks in a long-term treatment study. Out of these, 38 patients were converted to darbepoetin alfa administered once every 4 weeks for 20 weeks. Among these patients, 36 patients were considered evaluable; wherein 30 patients successfully maintained the target haemoglobin between 10.0 and 13.0 g/dl.

It was found that for successful patients the mean (SD) haemoglobin during evaluation was 11.16 (0.60) g/dl while the mean change in haemoglobin from baseline to evaluation was -0.26 g/dl. Also, the median change from baseline in average weekly darbepoetin alfa dose was 1.61 micro gram. 

Thus, it can be concluded that darbepoetin alfa, administered once monthly, may help to maintain haemoglobin effectively and safely in most dialysis patients stabilized previously on once every 2 weeks dosing. This may help optimize anaemia management for patients with CRF and also for health care providers.