Anemia Control in Kidney Transplant Recipients Using Once-Monthly Continuous Erythropoietin Receptor Activator: A Prospective, Observational Study

Abstract

In a multicenter, prospective, observational study of 279 kidney transplant recipients with anemia, the efficacy and safety of once-monthly continuous erythropoietin receptor activator (C.E.R.A.) were assessed to a maximum of 15 months. The main efficacy variable was the proportion of patients achieving a hemoglobin level of 11-12 g/dL at each of visits between months 7 and 9. At study entry, 224 patients (80.3%) were receiving erythropoiesis stimulating agent (ESA) therapy including darbepoetin alfa (98), epoetin beta (61), and C.E.R.A. (45). The mean (SD) time between C.E.R.A. applications was 34.0 (11.9) days. Among 193 patients for whom efficacy data were available, mean (SD) hemoglobin was 11.1 (0.99) g/dL at study entry, 11.5 (1.1) g/dL at month 7, 11.6 (1.3) g/dL at month 9, and 11.4 (1.1) g/dL at month 15. During months 7–9, 20.7% of patients had all hemoglobin values within the range 11-12 g/dL and 64.8% were within 10–13 g/dL. Seven patients (2.5%) discontinued C.E.R.A. due to adverse events or serious adverse events. In this observational trial under real-life conditions, once-monthly C.E.R.A. therapy achieved stable hemoglobin levels in stable kidney transplant recipients with good tolerability, and with no requirement for any dose change in 43% of patients.

Longitudinal Evaluation of Cytopenias in the Renal Transplant Population

“…The only clinically relevant difference detected between immunosuppression regimens was belatacept patients’ increased average hemoglobin range, which may be associated with the increase in average estimated glomerular filtration rate posttransplant seen in belatacept patients compared with patients on calcineurin inhibitors. 36,37 On logistic regression, patients on tacrolimus immunosuppression were also more likely to develop thrombocytopenia and pancytopenia, which persisted on multivariable regression. Although it is possible this is related to residual selection bias between immunosuppression regimens, we have attempted to exclude tacrolimus-treated patients who would not be eligible for belatacept immunosuppression.…”

Treatment of anemia in difficult-to-manage patients with chronic kidney disease

“…88 Continuous erythropoietin receptor activator therapy also effectively maintained stable hemoglobin levels over 15 months in a real-world study of kidney transplant patients. 89 Similarly, a 1-year study of 77 patients showed stable iron and creatinine levels and a small increase in hemoglobin levels after conversion from short-acting ESAs (epoetin alfa or darbepoetin alfa) to continuous erythropoietin receptor activator therapy at dosages of 50-150 mg/mo. 90…”

Influence of anemia on quality of life in patients with chronic kidney disease on renal replacement therapy

“…Hemoglobin, red blood cells, hematocrit and serum iron were higher in the group of kidney transplant recipients than in the group of patients on RRT, and comparable with the group of patients with CKD 3. This is, probably, due to decreasing uremia in most patients after kidney transplantation [2].…”