Continuous EPO receptor activator therapy of anemia in children under peritoneal dialysis

Abstract

The short half-life of erythropoietin (rHuEPO) leads to repeated fluctuations in hemoglobin levels and the need for frequent administration. Continuous erythropoietin receptor activator (CERA) therapy has been approved for once or twice a month in adult dialysis patients. To evaluate the efficacy and safety of CERA therapy in the management of anemia in pediatric peritoneal dialysis (PD) stable PD children under twice-a-week EPO were converted to a subcutaneous CERA, scheduled every 2 weeks. The follow-up was 6 months. The primary efficacy parameter was hemoglobin> 11 g/dL. The exclusion criteria were ferritin <100 ng/ml and Hb saturation <20%. Sixteen children, aged 9.75 ± 3.6 years, including 11 boys, participated in the study. Mean Hb level at month 0 was 10.8 ± 1.9 g/dL. A decrease in hemoglobin to 10.38 ± 1 g/dL at month 2 was observed. The CERA dose was increased from 0.86 ± 0.33 to 1.67 ± 0.4 μg/kg at month 3. The target Hb level was reached by the 3rd month. The Hb level and CERA dose were 12.2 ± 1.2 and 1.6 ± 0.67 μg/kg respectively at the end of the study. No adverse events were observed during the protocol. CERA is an effective and safe therapy for maintaining hemoglobin levels when administered twice, up to once a month, in PD children. Doses required to reach target Hb were higher than published experiences in adult populations.

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

“…An increasing number of studies have examined the outcomes (e.g., dose, frequency, side effects) of CERA therapy in children, which was developed as a longacting ESA [238,239]. The decrease in dosing frequency in children may be beneficial not only for reducing the burden on medical workers and increasing safety, as in adults, but also for improving medication compliance and reducing the burden on family members.…”

Efficacy and Long-Term Safety of C.E.R.A. Maintenance in Pediatric Hemodialysis Patients with Anemia of CKD

“…There are currently limited data on the efficacy and safety of C.E.R.A. in pediatric patients, with two small studies reporting attainment of target hemoglobin levels without adverse drug reactions (10,11). This study was undertaken to determine the conversion factor that allows switching from other ESAs to C.E.R.A.…”

Use of erythropoiesis-stimulating agents in children with chronic kidney disease: a systematic review

“…No randomized trials were identified regarding CERA use in children. Three observational studies evaluated CERA in 92 children [ 49 , 60 , 61 ]. Cano et al.…”

“…Cano et al. [ 61 ] studied 16 children over 6 months converted from rHuEPO to fortnightly subcutaneous CERA. They found Hb was maintained, although dosing varied significantly (0.5–2.9 µg/kg/dose).…”