A new study conducted on hemodialytic patients suggests that conversion of Darbepoetin-α to Epoetin-α does not improve cost and efficacy. This study was published in the journal, Giornale italiano di nefrologia.

In this study, 12 clinically stable patients on hemodialysis were administered Darbepoetin-α (DARB) for a period of 16 months. These single weekly doses of Darbepoetin-α were converted to EPO-α and administered 2-3 times/week. Dose-conversion ratio (DCR) of 200 IU EPO-α = 1 mcg DARB was used to calculate initial dose of EPO-α. Six months before the conversion, the mean Hb value was between 11 and 12 g/dL while the monthly dose of DARB remained unchanged/reduced during the last 3 months.

It was found that during the last month of treatment with DARB, the mean Hb value of the group was 11.4±0.5 g/dL while the mean weekly dose/patient was 24±12 mcg. Later on, after 2 months of using EPO-α, the mean Hb value dropped to 10.8±0.7 g/dL while the mean monthly dose/patient was 5.667±2.229 IU, which corresponded to a DCR of 234. In order to achieve Hb values above 11 g/dL, doses of EPO-α were steadily increased up to a maximum of 10.000±5.461 IU/patient, bringing the DCR to 414.

From the above results obtained, it can be evident that converting darbepoetin-α to an ESA with a seemingly lower cost, may result in worsening of anemia in hemodialysis patients, leading to increased expenditures.

According to a recent study, patients with kidney failure were known to benefit from high-dose hemodiafiltration as compared with standard hemodialysis. This study’s results were published in The New England Journal of Medicine.

This study was a multinational, pragmatic, randomized, controlled trial that included 1360 patients with kidney failure who had received high-flux hemodialysis for a period of at least 3 months. Out of these, 683 were assigned to high dose hemodiafiltration and 677 continued on high flux hemodialysis[SB1] . All the patients were deemed to be candidates for a convection volume of at least 23 liters per session [SB2] . The primary outcome measured was death due to any cause. The time for median follow-up was 30 months.

It was observed that the mean convection volume in the hemodiafiltration group was found to be 25.3 liters/session. While death due to any cause was 118 patients in the hemodiafiltration group, it was seen in 148 patients in the hemodialysis group.

Hence, it may be concluded that in patients with kidney failure resulting in kidney-replacement therapy, high-dose hemodiafiltration was found to lower risk of death due to any cause than conventional high-flux hemodialysis and therefore, may be a better option for use.

According to the recent clinical study report, finerenone provides better control of cardiovascular (CV) and kidney outcomes in patients with T2D and chronic kidney disease. This study was published in the European Heart Journal. Cardiovascular Pharmacotherapy.

This randomized controlled study aimed to compare finerenone vs. placebo in patients with and without baseline history of atherosclerotic CV disease (ASCVD). The outcomes evaluated were composite CV outcome, CV death or HHF, and a composite kidney outcome, all-cause mortality, and safety.

45.6% of the patients included in the study had a history of ASCVD. The occurrence of composite CV outcome, CV death or HHF, and all-cause mortality was higher in patients with ASCVD vs. those without. Finerenone reduced outcomes in patients with and without ASCVD, compared to placebo.

Based on the results of the study, finerenone can decrease the risk of CV and kidney outcomes consistently across the spectrum of CKD in patients with T2D, irrespective of prevalent ASCVD.

Finerenone reduces 24-h, daytime, and night-time systolic blood pressure in patients with chronic kidney disease and type 2 diabetes, says a latest study published in the Journal of Hypertension.

This phase 2b trial assessed the effects of finerenone on 24-h ambulatory BP in 823 patients with type 2 diabetes and chronic kidney disease. The study included patients with albumin-to-creatinine ratio ≥30 mg/g and estimated glomerular filtration rate of 30-90 ml/min per 1.73 m2. The participants were randomized to receive wither finerenone (1.25-20 mg once daily in the morning) administered over 90 days or placebo. Ambulatory BP monitoring (ABPM) over 24 h was performed in a subset of 240 patients at screening, Day 60, and Day 90.

At Day 90, the 24-h ABPM systolic BP (SBP) was -8.3 mmHg for finerenone 10 mg (n = 27), -11.2 mmHg for finerenone 15 mg (n = 34), and -9.9 mmHg for finerenone 20 mg (n = 31). Mean daytime and night-time SBP recordings were similarly reduced and finerenone did not increase the incidence of SBP dipping.

According to the results, finerenone can reduce 24-h, daytime, and night-time SBP and these changes in the BP can be persistent over 24 h with once-daily dosing in the morning.