Skip to main content
SpringerLink
Log in

Darbepoetin alfa for the treatment of anemia in children undergoing peritoneal dialysis: a multicenter prospective study in Japan

  • Original Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Darbepoetin alfa (DA) is an attractive alternative to recombinant human erythropoietin (rHuEPO) in managing renal anemia. Since DA has not been approved by the appropriate Japanese drug regulatory agencies for the indication of renal anemia in children in Japan, we have conducted a multicenter prospective study to determine the efficacy and safety of DA in Japanese children undergoing peritoneal dialysis (PD).

Methods

Pediatric patients subcutaneously receiving rHuEPO were switched to DA treatment for a period of 28 weeks. The conversion to the initial dose of DA was calculated as 1 μg DA for 200 IU rHuEPO, and DA was administered intravenously once every 2 weeks. The target hemoglobin (Hb) concentration was defined as 11.0 to ≤13.0 g/dL. In some patients, the dose of DA was adjusted appropriately to achieve this target level, and/or the dosing frequency changed to once every 4 weeks.

Results

In the 25 patients switched from rHuEPO to DA the mean Hb concentration increased from 9.9 ± 1.0 to 11.1 ± 1.0 g/dL at 8 weeks following commencement of the DA treatment. The target Hb concentration was achieved in 88 % of these patients, and 60 % maintained this target value on completion of the study. The dosing frequency was extended to once every 4 weeks in 60 % of patients. Twenty-four adverse events were noted in 11 of 25 patients (44 %); however, there was no causality between DA and adverse events.

Conclusions

The results of this study suggest that intravenous administration of DA once every 2 or 4 weeks is an effective and safe treatment for renal anemia in Japanese children undergoing PD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Koshy SM, Geary DF. Anemia in children with chronic kidney disease. Pediatr Nephrol. 2008;23:209–19.

    Article  PubMed  Google Scholar 

  2. Gary Lerner, Kale AS, Warady BA, Jabs K, Bunchman TE, Heatherington A. Pharmacokinetics of darbepoetin alfa in pediatric patients with chronic kidney disease. Pediatr Nephrol. 2002;17:933–7.

    Article  Google Scholar 

  3. Brunkhorst R, Bommer J, Braum J, Hagg-Weber M, Gill C, Wagner J, et al. Darbepoetin alfa effectively maintains hemoglobin concentrations at extended dose intervals relative to intravenous or subcutaneous recombinant human erythropoietin in dialysis patients. Nephrol Dial Transplant. 2004;19:1224–30.

    Article  PubMed  CAS  Google Scholar 

  4. Jadoul M, Vanrenterghem Y, Foret M, Walker R, Gray SJ. Darbepoetin alfa administered once monthly maintains hemoglobin levels in stable dialysis patients. Nephrol Dial Transplant. 2004;19:898–903.

    Article  PubMed  CAS  Google Scholar 

  5. Hiramatsu M, Kubota M, Iwasaki M, Akizawa T, Kosikawa, and the KRN321 A09 Study Group. Darbepoetin alfa (KRN321) administered intravenously once monthly maintain hemoglobin levels in peritoneal dialysis patients. Ther Apher Dial. 2008;12:19–27.

    Article  PubMed  CAS  Google Scholar 

  6. Kubota M, Hiramatsu M, Yamakawa M, Fukuhara S, Morita S, Iwasaki M, et al. Darbepoetin alfa (KRN321) is safe and effective when administered subcutaneously once every 2 or 4 weeks to patients on peritoneal dialysis in Japan. Clin Exp Nephrol. 2011;15:884–92.

    Article  PubMed  CAS  Google Scholar 

  7. De Palo T, Giordano M, Palumbo F, Bellantuono R, Messina G, Colella V, et al. Clinical experience with darbepoetin alfa (NESP) in children undergoing hemodialysis. Pediatr Nephrol. 2004;19:337–40.

    Article  PubMed  Google Scholar 

  8. Geary DF, Keating LE, Vigneux A, Stephens D, Hebert D, Harvey EA. Darbepoetin alfa (AranespTM) in children with chronic renal failure. Kidney Int. 2005;68:1759–65.

    Article  PubMed  CAS  Google Scholar 

  9. Warady BA, Arar MY, Lerner G, Nakanishi AM, Stehman-Breen C. Darbepoetin alfa for the treatment of anemia in pediatric patients with chronic kidney disease. Pediatr Nephrol. 2006;21:1144–52.

    Article  PubMed  Google Scholar 

  10. Andre JL, Deschenes G, Boudailliez B, Broux F, Fischbach M, Gagnadoux M-F, et al. Darbepoetin, effective treatment of anaemia in paediatric patients with chronic renal failure. Pediatr Nephrol. 2007;22:708–14.

    Article  PubMed  Google Scholar 

  11. Japanese Society for Dialysis Therapy. 2008 Japanese Society for Dialysis Therapy guideline for renal anemia in chronic kidney disease. J Jpn Soc Dial Ther 2008; 41:661–716.

    Google Scholar 

  12. Japanese Society for Dialysis Therapy. An overview of dialysis treatment in Japan (as of Dec. 31, 2008). J Jpn Soc Dial Ther 2010; 43:1–35.

    Google Scholar 

  13. Cummings EA, Reid GJ, Finley GA, McGrath PJ, Ritchie JA. Prevalence and source of pain in pediatric inpatients. Pain. 1996;68:25–31.

    Article  PubMed  CAS  Google Scholar 

  14. Schmitt CP, Nau B, Brummer C, Rosenkranz J, Schaefer F. Increase injection pain with darbepoetin-α compared to epoetin-β in paediatric dialysis patients. Nephrol Dial Transplant. 2006;21:3520–4.

    Article  PubMed  CAS  Google Scholar 

  15. Macdougal IC, Gray SJ, Elston O, et al. Pharmacokinetics of novel erythropoiesis stimulating protein compared with epoetin alfa in dialysis patients. J Am Soc Nephrol. 1999;10:2392–5.

    Google Scholar 

  16. Hiramatsu M, Kubota M, Yamamoto H. Limitation of rHuEPO treatment for target Hb in peritoneal dialysis patients (in Japanese). Kidney Dial. 2007;63:915–22.

    CAS  Google Scholar 

  17. North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). 2004 Annual Report. NAPRTCS Administrative Office, Boston, 2004.

  18. Rijk Y, Raaijmakers R, Kar N, Schroder C. Intraperitoneal treatment with darbepoetin for children on peritoneal dialysis. Pediatr Nephrol. 2007;22:436–40.

    Article  PubMed  Google Scholar 

  19. Durkan AM, Keating LE, Vigneux A, Geary DF. The use of darbepoetin in infants with chronic renal impairment. Pediatr Nephrol. 2006;21:694–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge Drs. Tomoyuki Sakai and Kenji Ishikura (Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan) and Yasushi Tsutumi (Department of Pediatrics, Kyushu University) for advice during this study. This study was supported by a grant from the Japan Dialysis Outcome Group (Grant #07009).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, School of Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Motoshi Hattori & Yuko Akioka

  2. Department of Pediatrics, Yamagata City Hospital Saiseikan, 1-3-26 Nanokamachi, Yamagata, Yamagata, 990-8533, Japan

    Akira Matsunaga

  3. Division of Nephrology, Saitama Children’s Medical Center, 2100 Magome, Iwatsuki-ku, Saitama, Saitama, 339-8551, Japan

    Shuichiro Fujinaga

  4. Department of Pediatric Nephrology, Aichi Children’s Health and Medical Center, 1-2 Osakada, Morioka-cho, Obu, Aichi, 474-8710, Japan

    Takuhito Nagai & Osamu Uemura

  5. Department of Pediatrics, Osaka Medical Collage, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    Hyogo Nakakura & Akira Ashida

  6. Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan

    Koichi Kamei & Shuichi Ito

  7. Department of Pediatrics, Nagoya Daini Red Cross Hospital, 2-9 Myokencho, Showa-ku, Nagoya, Aichi, 466-0814, Japan

    Takuji Yamada & Yoshimitsu Goto

  8. Department of Pediatric Nephrology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, Hiroshima, 734-0004, Japan

    Toshiyuki Ohta

  9. Department of Nephrology, Chiba Children’s Hospital, 579-1 Hetacho, Midori-ku, Chiba, Chiba, 266-0007, Japan

    Masataka Hisano

  10. Division of Nephrology, Department of Medicine, St. Luke’s International Hospital, 91 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Yasuhiro Komatsu

  11. Kidney Center, Nikko Memorial Hospital, 1-5-13 Shintomi-cho, Muroran, 051-0005, Japan

    Noritomo Itami

Authors
  1. Motoshi Hattori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Matsunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuko Akioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuichiro Fujinaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takuhito Nagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Osamu Uemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hyogo Nakakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akira Ashida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koichi Kamei
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shuichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takuji Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yoshimitsu Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Toshiyuki Ohta
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masataka Hisano
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yasuhiro Komatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Noritomo Itami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Motoshi Hattori.

About this article

Cite this article

Hattori, M., Matsunaga, A., Akioka, Y. et al. Darbepoetin alfa for the treatment of anemia in children undergoing peritoneal dialysis: a multicenter prospective study in Japan. Clin Exp Nephrol 17, 582–588 (2013). https://doi.org/10.1007/s10157-012-0714-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-012-0714-3

Keywords

Search

Navigation