Treatment for Anemia of Chronic Kidney Disease
Chronic Kidney Failure
Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Although there are many mechanisms involved in the pathogenesis of renal anemia, the primary cause is the inadequate production of erythropoietin by the damaged kidneys.
When erythropoietin levels are low, an inadequate number of oxygen-carrying red blood cells are produced. By 1990, recombinant human erythropoietin (epoetin) was licensed in the United States and Europe for the treatment of anemia associated with chronic renal failure, including patients on dialysis (end-stage renal disease) and patients not on dialysis.
Indistinguishable from endogenous erythropoietin, epoetin binds the dimerized erythropoietin receptor on the surface of erythroid progenitor cells. Epoetin is highly effective at stimulating erythropoiesis and produces a consistent increase in hemoglobin levels.
A large randomized, double-blind, multicenter noninferiority study conducted in over 500 hemodialysis patients demonstrated that once-weekly darbepoetin alfa was as effective in maintaining hemoglobin levels as epoetin dosed 3 times weekly for the treatment of anemia.
The transition from epoetin alfa to darbepoetin alfa therapy is usually uncomplicated. The approximate conversion is 200 IU of epoetin alfa to 1 mcg of darbepoetin alfa. New patients were administered darbepoetin 60 mcg every 2 weeks. Despite the successes of epoetin alfa and darbepoetin alfa, the management of anemia of CKD is poised for further clinical advancement. Also in the development stages for the treatment of anemia of CKD are the erythropoietin-mimetic peptides.
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Anemia of Chronic Kidney Disease, erythropoietin-mimetic, hemodialysis, multicenter noninferiority
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