Effect of conversion from ESA with shorter half-life to CERA once monthly for maintaining Hb concentration in pre-dialysis CKD patients

Ji Young Choi, Chul Woo Yang, Yeong Hoon Kim, Kwon Wook Joo, TaeHyun Yoo, Kang Wook Lee, Sang Ho Lee, Ju Young Moon, Sug Kyun Shin, Wooseong Huh, Nam Ho Kim, Sun Hee Park, Chan Duck Kim, Yong Lim Kim

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: The purpose of this study is to identify whether hemoglobin (Hb) concentrations can be maintained, and to investigate changes in biomarkers, when switching from erythropoietin stimulating agents (ESA) with shorter half-life to once-monthly subcutaneous methoxy polyethylene glycol-epoetin β (CERA) in pre-dialysis chronic kidney disease (CKD) patients. Methods: Pre-dialysis CKD patients (n=191) aged ≥18 years who maintained their Hb level 10-12 g/dL through use of epoetin-α, epoetin-β, or darbepoetin-α were enrolled. Hb levels and CERA dose was assessed prospectively for 24 weeks. Serum biomarkers related to coagulation, endothelial function, and iron metabolism were measured at weeks 0 and 24. Results: Baseline Hb concentration was 10.8±0.6 g/dL Twelve and 24 weeks after conversion, mean Hb levels were 11.9±0.9 and 11.2±0.9 g/dL, respectively. The mean monthly CERA dose required to maintain Hb levels was gradually reduced. Of total 387 dose adjustments, dose increases and decreases occurred in 35 (9.0%) and 352 (91.0%) episodes, respectively. Hb overshoot occurred in 14 (9.7%) patients. P-selectin was significantly decreased, whereas VCAM was significantly increased 24 weeks after conversion (P < 0.05). Serum soluble transferrin receptor E-selectin and prohepcidin levels were similar before and after switching to CERA (P=N-S). Conclusion: Conversion from ESA with shorter half-life to subcutaneous once-monthly CERA in pre-dialysis CKD patients can efficaciously maintain Hb. The CERA dose requirement decreased significantly. The conversion ratio may need to be reduced when switching from ESA with shorter half-life to CERA. CERA may change biomarkers associated with platelet reactivity and endothelial microenvironment.

Original languageEnglish
Pages (from-to)259-268
Number of pages10
JournalKidney and Blood Pressure Research
Volume37
Issue number4-5
DOIs
Publication statusPublished - 2013 Nov 1

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Erythropoietin
Chronic Renal Insufficiency
Half-Life
Dialysis
Hemoglobins
Biomarkers
Hepcidins
Transferrin Receptors
P-Selectin
E-Selectin
Serum
Blood Platelets
Iron

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Cardiology and Cardiovascular Medicine

Cite this

Choi, Ji Young ; Yang, Chul Woo ; Kim, Yeong Hoon ; Joo, Kwon Wook ; Yoo, TaeHyun ; Lee, Kang Wook ; Lee, Sang Ho ; Moon, Ju Young ; Shin, Sug Kyun ; Huh, Wooseong ; Kim, Nam Ho ; Park, Sun Hee ; Kim, Chan Duck ; Kim, Yong Lim. / Effect of conversion from ESA with shorter half-life to CERA once monthly for maintaining Hb concentration in pre-dialysis CKD patients. In: Kidney and Blood Pressure Research. 2013 ; Vol. 37, No. 4-5. pp. 259-268.
@article{73c3354eb50444149e44c434fdf78486,
title = "Effect of conversion from ESA with shorter half-life to CERA once monthly for maintaining Hb concentration in pre-dialysis CKD patients",
abstract = "Background: The purpose of this study is to identify whether hemoglobin (Hb) concentrations can be maintained, and to investigate changes in biomarkers, when switching from erythropoietin stimulating agents (ESA) with shorter half-life to once-monthly subcutaneous methoxy polyethylene glycol-epoetin β (CERA) in pre-dialysis chronic kidney disease (CKD) patients. Methods: Pre-dialysis CKD patients (n=191) aged ≥18 years who maintained their Hb level 10-12 g/dL through use of epoetin-α, epoetin-β, or darbepoetin-α were enrolled. Hb levels and CERA dose was assessed prospectively for 24 weeks. Serum biomarkers related to coagulation, endothelial function, and iron metabolism were measured at weeks 0 and 24. Results: Baseline Hb concentration was 10.8±0.6 g/dL Twelve and 24 weeks after conversion, mean Hb levels were 11.9±0.9 and 11.2±0.9 g/dL, respectively. The mean monthly CERA dose required to maintain Hb levels was gradually reduced. Of total 387 dose adjustments, dose increases and decreases occurred in 35 (9.0{\%}) and 352 (91.0{\%}) episodes, respectively. Hb overshoot occurred in 14 (9.7{\%}) patients. P-selectin was significantly decreased, whereas VCAM was significantly increased 24 weeks after conversion (P < 0.05). Serum soluble transferrin receptor E-selectin and prohepcidin levels were similar before and after switching to CERA (P=N-S). Conclusion: Conversion from ESA with shorter half-life to subcutaneous once-monthly CERA in pre-dialysis CKD patients can efficaciously maintain Hb. The CERA dose requirement decreased significantly. The conversion ratio may need to be reduced when switching from ESA with shorter half-life to CERA. CERA may change biomarkers associated with platelet reactivity and endothelial microenvironment.",
author = "Choi, {Ji Young} and Yang, {Chul Woo} and Kim, {Yeong Hoon} and Joo, {Kwon Wook} and TaeHyun Yoo and Lee, {Kang Wook} and Lee, {Sang Ho} and Moon, {Ju Young} and Shin, {Sug Kyun} and Wooseong Huh and Kim, {Nam Ho} and Park, {Sun Hee} and Kim, {Chan Duck} and Kim, {Yong Lim}",
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Choi, JY, Yang, CW, Kim, YH, Joo, KW, Yoo, T, Lee, KW, Lee, SH, Moon, JY, Shin, SK, Huh, W, Kim, NH, Park, SH, Kim, CD & Kim, YL 2013, 'Effect of conversion from ESA with shorter half-life to CERA once monthly for maintaining Hb concentration in pre-dialysis CKD patients', Kidney and Blood Pressure Research, vol. 37, no. 4-5, pp. 259-268. https://doi.org/10.1159/000350151

Effect of conversion from ESA with shorter half-life to CERA once monthly for maintaining Hb concentration in pre-dialysis CKD patients. / Choi, Ji Young; Yang, Chul Woo; Kim, Yeong Hoon; Joo, Kwon Wook; Yoo, TaeHyun; Lee, Kang Wook; Lee, Sang Ho; Moon, Ju Young; Shin, Sug Kyun; Huh, Wooseong; Kim, Nam Ho; Park, Sun Hee; Kim, Chan Duck; Kim, Yong Lim.

In: Kidney and Blood Pressure Research, Vol. 37, No. 4-5, 01.11.2013, p. 259-268.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of conversion from ESA with shorter half-life to CERA once monthly for maintaining Hb concentration in pre-dialysis CKD patients

AU - Choi, Ji Young

AU - Yang, Chul Woo

AU - Kim, Yeong Hoon

AU - Joo, Kwon Wook

AU - Yoo, TaeHyun

AU - Lee, Kang Wook

AU - Lee, Sang Ho

AU - Moon, Ju Young

AU - Shin, Sug Kyun

AU - Huh, Wooseong

AU - Kim, Nam Ho

AU - Park, Sun Hee

AU - Kim, Chan Duck

AU - Kim, Yong Lim

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background: The purpose of this study is to identify whether hemoglobin (Hb) concentrations can be maintained, and to investigate changes in biomarkers, when switching from erythropoietin stimulating agents (ESA) with shorter half-life to once-monthly subcutaneous methoxy polyethylene glycol-epoetin β (CERA) in pre-dialysis chronic kidney disease (CKD) patients. Methods: Pre-dialysis CKD patients (n=191) aged ≥18 years who maintained their Hb level 10-12 g/dL through use of epoetin-α, epoetin-β, or darbepoetin-α were enrolled. Hb levels and CERA dose was assessed prospectively for 24 weeks. Serum biomarkers related to coagulation, endothelial function, and iron metabolism were measured at weeks 0 and 24. Results: Baseline Hb concentration was 10.8±0.6 g/dL Twelve and 24 weeks after conversion, mean Hb levels were 11.9±0.9 and 11.2±0.9 g/dL, respectively. The mean monthly CERA dose required to maintain Hb levels was gradually reduced. Of total 387 dose adjustments, dose increases and decreases occurred in 35 (9.0%) and 352 (91.0%) episodes, respectively. Hb overshoot occurred in 14 (9.7%) patients. P-selectin was significantly decreased, whereas VCAM was significantly increased 24 weeks after conversion (P < 0.05). Serum soluble transferrin receptor E-selectin and prohepcidin levels were similar before and after switching to CERA (P=N-S). Conclusion: Conversion from ESA with shorter half-life to subcutaneous once-monthly CERA in pre-dialysis CKD patients can efficaciously maintain Hb. The CERA dose requirement decreased significantly. The conversion ratio may need to be reduced when switching from ESA with shorter half-life to CERA. CERA may change biomarkers associated with platelet reactivity and endothelial microenvironment.

AB - Background: The purpose of this study is to identify whether hemoglobin (Hb) concentrations can be maintained, and to investigate changes in biomarkers, when switching from erythropoietin stimulating agents (ESA) with shorter half-life to once-monthly subcutaneous methoxy polyethylene glycol-epoetin β (CERA) in pre-dialysis chronic kidney disease (CKD) patients. Methods: Pre-dialysis CKD patients (n=191) aged ≥18 years who maintained their Hb level 10-12 g/dL through use of epoetin-α, epoetin-β, or darbepoetin-α were enrolled. Hb levels and CERA dose was assessed prospectively for 24 weeks. Serum biomarkers related to coagulation, endothelial function, and iron metabolism were measured at weeks 0 and 24. Results: Baseline Hb concentration was 10.8±0.6 g/dL Twelve and 24 weeks after conversion, mean Hb levels were 11.9±0.9 and 11.2±0.9 g/dL, respectively. The mean monthly CERA dose required to maintain Hb levels was gradually reduced. Of total 387 dose adjustments, dose increases and decreases occurred in 35 (9.0%) and 352 (91.0%) episodes, respectively. Hb overshoot occurred in 14 (9.7%) patients. P-selectin was significantly decreased, whereas VCAM was significantly increased 24 weeks after conversion (P < 0.05). Serum soluble transferrin receptor E-selectin and prohepcidin levels were similar before and after switching to CERA (P=N-S). Conclusion: Conversion from ESA with shorter half-life to subcutaneous once-monthly CERA in pre-dialysis CKD patients can efficaciously maintain Hb. The CERA dose requirement decreased significantly. The conversion ratio may need to be reduced when switching from ESA with shorter half-life to CERA. CERA may change biomarkers associated with platelet reactivity and endothelial microenvironment.

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