Aim : In this study, we investigated the efficacy and safety of conversion stable hemodialysis patients from the current short-acting r-HuEPO (EPO beta) to the long-acting darbepoetin.
Method : The study included 12 months of darbepoetin administration. The mean initial conversion ratio was 350 IU of short acting r-HuEPO to 1 microgram of darbepoetin. We adjusted the dose of darbepoetin to maintain hemoglobin levels between 11-12 g/dL. The study was carried out on 2 consecutive phases of 12 weeks each. Success with the extended dosing interval was defined as maintenance of mean hemoglobin> 10.0 g/dl during each phase.
Result : There were 26 patients who fulfilled the entry criteria. Their mean age was 47.0 ± 17.13 years, and the mean duration on hemodialysis was 55.8 ± 14.0 months. The mean weekly dose increased from 28.75 ± 4.2 μg in the biweekly frequency of dosing to 38.5±3.9 μg after switching to the monthly protocol. The hemoglobin levels were maintained at therapeutic range without statistically significant change throughout the study; the mean hemoglobin levels was 10.81± .86 g/L at start of the study and 10.86 ± .76 g/L at the end of 6 months. Continuing the darbepoetin in 12 patients for one year disclosed no significant change of the conversion ratio of the drug, and the mean hemoglobin levels remained within the targeted limits.
Conclusion: Darbepoetin alpha is effective and safe for the treatment anemia in hemodialysis patients even at monthly dose intervals and for long-term. With the the above mentioned conversion ratio and current prices, darbepoetin seems more expensive than the short acting erythropoetin beta by 15%, 58 % for the biweekly and monthly doses respectively. However, the longer dosing intervals are certainly much better convenience to patients and care takers in comparison with the currently used short acting ESAs.
