Fixed dose of long‐acting erythropoietic stimulating agents at higher frequency improves appetite, reduces inflammation and corrects anaemia in patients on haemodialysis

Abstract

Anaemia is an important issue in patients undergoing haemodialysis. We aimed to identify a better dosing schedule of a fixed monthly dose of continuous erythropoietin receptor activator (CERA) in patients with chronic kidney disease (CKD) on haemodialysis. The CERA dosing schedule included 100 μg once monthly for 2 months, 50 μg twice monthly for 2 months and then 100 μg once monthly for two months. The effectiveness was determined by comparing haematocrit, nutritional status (serum protein and albumin) and inflammatory markers (tumour necrosis factor (TNF)-α, interleukin (IL)-1, IL-6 and Hepcidin) at the beginning of the study with those at the end of the study. Forty-seven out of 67 patients completed the trial. At the end, haematocrit was significantly higher (34.51 vs 33.22%, P=.004), levels of inflammatory markers were significantly lower (TNF-α (30.71 vs 35.67 ng/mL, P=.007), IL-6 (5.12 vs 7.95 ng/mL, P=.033), hepcidin (60.39 vs 74.39 ng/mL, P=.002)), blood glucose levels were significantly lower (112.40 vs 139.02 mg/dL, P=.003) and albumin was significantly higher (4.11 vs 3.98, P=.001). Patients with a better than average response had a lower initial number of red blood cells (3.3 vs 3.6 × 10(6) /mm(3) , P=.025) and a lower IL-1 (3.8 vs 12.9 ng/mL, P=.01). They also had significantly lower blood glucose levels at the end. (91.3 vs 124.0 mg/dL, P=.03). We demonstrate that a fixed monthly dose of CERA at a twice monthly dosing schedule improves nutrition, reduces the inflammation and corrects anaemia in patients on haemodialysis. This finding may provide a new strategy for treating CKD-related anaemia.

Associations between perfluorinated chemicals and serum biochemical markers and performance status in uremic patients under hemodialysis

“…Uremic patients may still have residual renal function and urine output. More than forty percent of uremia in Taiwan is a result of DM [ 20 ]. More than half of the hypertension medications used in the study group were renin-angiotensin-aldersterone system (RAAS) blockers.…”

“…The prevalence of CKD and renal failure are high in Taiwan [ 19 , 20 ]. Uremic patients tend to accumulate toxins in their body and commonly suffer from cardiovascular diseases (CVD) and poor function status.…”

Intradialytic parenteral nutrition using a standard amino acid solution not for renal failure in maintenance hemodialysis patients with malnutrition: a multicenter pilot study

“…Third, participants who were hospitalized or visited the emergency room during the observation period were not excluded from this study. Thus, we cannot eliminate the influence of illness or medical treatment during admission, such as antibiotics, but we also believe that this is an unavoidable problem, as has been seen in other studies of dialysis patients with a high rate of hospitalization [39].…”

Current and Emerging Drugs in the Treatment of Anemia in Patients with Chronic Kidney Disease

“…ESAs may have renoprotective effects and slow the progression of CKD [62]. Long-acting ESAs tend to be more effective and stable than short-acting ESAs in treating anemia [63], and a fixed dose of long-acting ESAs at a higher frequency can improve appetite, reduce inflammation and correct anemia in patients on hemodialysis [64]. For predialysis patients with CKD, long-acting ESAs may be more useful, because of the lower frequency of hospital visits [65].…”