Conversion of darbepoetin to low doses of CERA maintains hemoglobin levels in non-dialysis chronic kidney disease patients

Background/Aims: Finding the lowest effective dose of erythropoietin-stimulating agents is critical in the management of renal anemia. We evaluated the efficacy of converting darbepoetin to CERA at doses lower than those usually recommended. Methods: We selected consecutive non-dialysis chronic kidney disease patients treated with darbepoetin doses <= 40 mcg/week in absence of iron deficiency, recent blood transfusion, bleeding, neoplasia, myocardial infarction/ stroke in the last 3 months. Darbepoetin <=20 mcg/ week was shifted to CERA 75 mcg/month, while darbepoetin 21–40 mcg/week to CERA 100 mcg/month. Primary endpoint was the change in hemoglobin (Hb goal, 11–13 g/dl) at month 3, 6, 9 and 12. Results: Studied patients (n = 37) were aged 70+/-13 years and GFR was 30+/-12 ml/min/1.73 m2 ; prevalence of males, diabetes and prior cardiovascular disease was 43, 45 and 40%, respectively. Before switching, efficacy population received darbepoetin 18+/-10 mcg/week with 28 patients receiving <=20 mcg/week. Prevalence of Hb goal at baseline was 75.7% and did not change at months 3 (70.3%), 6 (70.3%), 9 (72.2%), and 12 (80.0%). CERA dose remained unchanged during the study (81+/-11, 82+/-16, 91+/-30, 90+/-54 and 88+/-61 mcg/month). Out of the 438 visits performed, CERA dose was increased in 52 (11.9%) and reduced in 36 (8.2%) visits. Blood pressure, Hb, GFR, transferrin saturation and ferritin did not change. Conclusions: In chronic kidney disease patients treated with darbepoetin doses <=40 mcg/ week, CERA can be efficaciously used at doses lower than those recommended.