Darbepoetin Alfa in Young Infants With Renal Failure: Single Center Experience, a Case Series and Review of the Literature

Abstract

Background: Anemia treatment in infants with advanced or chronic kidney disease (CKD) represents an important challenge to nephrologists. The use of darbepoetin alfa, a novel erythropoiesis stimulating agent, has largely replaced recombinant human erythropoietin in older children and in adults with CKD. However, studies reporting the use of darbepoetin alfa in infants below 1 year of age are rare.Case presentation: We report the data of three infants with advanced stage kidney failure, aged 1, 4, and 7 months, who were treated with darbepoetin alfa and followed for 18–41 months. Hemoglobin levels increased in all three patients, reaching the target levels of 10.7–12 g/dl by 11, 19, and 22 weeks respectively, without any documented adverse effects. Patients younger than 1 year of age required a larger darbepoetin alfa dosage (ranged from 1.2 to 2.9 μg/kg per month) as compared to older children. A review of the literature found only three studies using darbepoetin alfa successfully in such young infants, with similar dosage and clinical success.Conclusion: In these three patients with advanced kidney disease, darbepoetin alfa was effective in correcting anemia with no observed side effects. It reinforces its potential use in very young patients with advanced CKD.

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

“…[ 55 ] and Libudzic-Nowak et al. [ 56 ] specifically investigated infants <1 year of age. Durkan et al.…”

“…Libudzic-Nowak et al. [ 56 ] achieved target Hb concentrations of 10.7–12 g/dL in three infants ages 1, 4 and 7 months, but requiring doses of 0.3–0.7 µg/kg/week, generally higher than in older children.…”

“…Small studies on infants demonstrate that particularly high ESA doses may be required [ 55 , 56 ]. Larger observational studies have also demonstrated higher ESA dose requirements in younger cohorts that appear consistent across ESA types [ 16 , 34 , 63 ].…”

Compassionate use of roxadustat for treatment of refractory renal anemia in an infant

“…This will lead to an attempt to increase the dose of ESAs to reach the Hb target. In some observational studies [ 9 , 10 ], it is interesting to note that even a higher dose of ESAs could not increase the rate to reach the Hb target in infants. ESA hyporesponsiveness and the safety concerns of high-dose ESAs urge clinicians to find new strategies to address renal anemia.…”

The use of darbepoetin alpha in infants

“…Прирост гемоглобина у пациента в возрасте 1 мес наблюдался через 11 нед после введения препарата, у ребенка 4 мес -через 19 нед и у 7-месячного -через 22 нед, при этом побочных эффектов не зарегистрировано. Авторами отмечено, что пациентам младше 1 года требуется более высокая дозировка дарбэпоэтина альфа (от 1,2 до 2,9 мкг/кг в месяц) по сравнению с детьми старшего возраста [17].…”