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Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients

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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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Authors and Affiliations

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

    Michio Kuwahara, Eriko Takehara, Yasunori Sasaki, Tomoharu Yoshimine, Keita Kusaka, Satomi Shikuma & Wataru Akita

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

    Youhei Arai & Shinichi Uchida

Authors
  1. Michio Kuwahara
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  2. Youhei Arai
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  3. Eriko Takehara
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  4. Yasunori Sasaki
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  5. Tomoharu Yoshimine
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  6. Keita Kusaka
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  7. Satomi Shikuma
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  8. Wataru Akita
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  9. Shinichi Uchida
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Correspondence to Michio Kuwahara.

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Kuwahara, M., Arai, Y., Takehara, E. et al. Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients. Clin Exp Nephrol 20, 585–594 (2016). https://doi.org/10.1007/s10157-015-1188-x

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  • DOI: https://doi.org/10.1007/s10157-015-1188-x

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