Estimated glomerular filtration rate reduces cost and patient burden in partial nephrectomy trials

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.

Once monthly administration of Darbepoetin alfa maintains haemoglobin levels in dialysis patients

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.

Maintenance of hemoglobin levels in hemodialysis patients after switching darbepoetin alfa administration schedule

A recent study suggests that a change in administration schedule of darbepoetin alfa intravenously from a once weekly (QW) schedule to a biweekly (Q2W) schedule results in effective maintenance of hemoglobin (Hb) levels in patients with chronic kidney disease receiving hemodialysis. This study was published in the journal, Renal Failure.

This was a prospective, open-label, single-center, single-arm study that included 104 patients. The participants who received darbepoetin alfa QW administered by the intravenous (IV) route were switched to a Q2W IV dosing schedule and followed for 24 weeks. The dosage of darbepoetin alfa was adjusted to maintain the target Hb concentration of 11-14 g/dL. The primary study endpoint was the change in resistance index (REI) on switching the administration schedule.

The results obtained showed that a significant decline in the erythropoiesis-stimulating agent (ESA) REI was observed over the 24-week follow-up, beginning with week 16. Based on the above results, it can be concluded that Hb levels may be effectively maintained after a change in administration schedule of darbepoetin alfa.

Cost and efficacy after conversion of Darbepoetin-α to Epoetin-α in hemodialytic patients

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.