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Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients.
Clin Exp Nephrol. 2016 Aug; 20(4):585-594.CE

Abstract

BACKGROUND

Renal anemia complicated with chronic kidney disease is usually treated with erythropoiesis-stimulating agents (ESAs). However, few studies have compared the early response of hemoglobin (Hb) to different kinds of ESAs.

METHODS

The effects of three types of ESAs-epoetin alfa or beta (EPO), darbepoetin alfa (DPO), and epoetin beta pegol (EPObp)-on renal anemia were followed in 416 pre-dialysis chronic kidney disease (CKD) patients. After the initial 12-week administration of ESAs, ΔHb/ESA dose/kg was calculated as an index of efficacy of each ESA. Furthermore, independent variables associated with ΔHb/ESA dose/kg (dependent variable) were determined using multiple linear regression analysis. The ten independent variables selected for analysis were: presence of diabetic nephropathy, estimated glomerular filtration rate (eGFR), Hb, albumin, iron (Fe), transferrin saturation (TSAT), ferritin, phosphate (P), intact parathyroid hormone (iPTH), and C-reactive protein.

RESULTS

The efficacy of DPO and EPObp were similar and higher than EPO. TSAT was most strongly correlated with ΔHb/EPO dose/kg in all three types of ESAs. Other significant independent factors were Hb, albumin, P, iPTH, and diabetic nephropathy in the EPO group, eGFR in the DPO group, and Fe in the EPObp group. The adjusted coefficient of determination (R (2)) ranged from 0.415 to 0.520 in the three ESA groups.

CONCLUSIONS

The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKD patients.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan. kuwaharam@shuuwa-gh.or.jp.

Department of Nephrology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.

Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.

Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.

Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.

Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.

Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.

Department of Nephrology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.

MeSH

AgedAged, 80 and overAnemiaErythropoietinFemaleHematinicsHumansLinear ModelsLongitudinal StudiesMaleMiddle AgedProspective StudiesRenal Insufficiency, Chronic

Pub Type(s)

Comparative Study

Journal Article

Language

eng

PubMed ID

26511877

Citation

Kuwahara, Michio, et al. "Early Response to Erythropoiesis-stimulating Agents in Non-dialysis Chronic Kidney Disease Patients." Clinical and Experimental Nephrology, vol. 20, no. 4, 2016, pp. 585-594.

Kuwahara M, Arai Y, Takehara E, et al. Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients. Clin Exp Nephrol. 2016;20(4):585-594.

Kuwahara, M., Arai, Y., Takehara, E., Sasaki, Y., Yoshimine, T., Kusaka, K., Shikuma, S., Akita, W., & Uchida, S. (2016). Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients. Clinical and Experimental Nephrology, 20(4), 585-594. https://doi.org/10.1007/s10157-015-1188-x

Kuwahara M, et al. Early Response to Erythropoiesis-stimulating Agents in Non-dialysis Chronic Kidney Disease Patients. Clin Exp Nephrol. 2016;20(4):585-594. PubMed PMID: 26511877.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients. AU - Kuwahara,Michio, AU - Arai,Youhei, AU - Takehara,Eriko, AU - Sasaki,Yasunori, AU - Yoshimine,Tomoharu, AU - Kusaka,Keita, AU - Shikuma,Satomi, AU - Akita,Wataru, AU - Uchida,Shinichi, Y1 - 2015/10/28/ PY - 2015/07/24/received PY - 2015/10/18/accepted PY - 2015/10/30/entrez PY - 2015/10/30/pubmed PY - 2019/3/21/medline KW - Darbepoetin alfa KW - Epoetin KW - Epoetin beta pegol KW - Renal anemia KW - Responsiveness to ESA SP - 585 EP - 594 JF - Clinical and experimental nephrology JO - Clin Exp Nephrol VL - 20 IS - 4 N2 - BACKGROUND: Renal anemia complicated with chronic kidney disease is usually treated with erythropoiesis-stimulating agents (ESAs). However, few studies have compared the early response of hemoglobin (Hb) to different kinds of ESAs. METHODS: The effects of three types of ESAs-epoetin alfa or beta (EPO), darbepoetin alfa (DPO), and epoetin beta pegol (EPObp)-on renal anemia were followed in 416 pre-dialysis chronic kidney disease (CKD) patients. After the initial 12-week administration of ESAs, ΔHb/ESA dose/kg was calculated as an index of efficacy of each ESA. Furthermore, independent variables associated with ΔHb/ESA dose/kg (dependent variable) were determined using multiple linear regression analysis. The ten independent variables selected for analysis were: presence of diabetic nephropathy, estimated glomerular filtration rate (eGFR), Hb, albumin, iron (Fe), transferrin saturation (TSAT), ferritin, phosphate (P), intact parathyroid hormone (iPTH), and C-reactive protein. RESULTS: The efficacy of DPO and EPObp were similar and higher than EPO. TSAT was most strongly correlated with ΔHb/EPO dose/kg in all three types of ESAs. Other significant independent factors were Hb, albumin, P, iPTH, and diabetic nephropathy in the EPO group, eGFR in the DPO group, and Fe in the EPObp group. The adjusted coefficient of determination (R (2)) ranged from 0.415 to 0.520 in the three ESA groups. CONCLUSIONS: The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKD patients. SN - 1437-7799 UR - https://www.unboundmedicine.com/medline/citation/26511877/Early_response_to_erythropoiesis_stimulating_agents_in_non_dialysis_chronic_kidney_disease_patients_ DB - PRIME DP - Unbound Medicine ER -