Efficacy of continuous erythropoietin receptor activator for end-stage renal disease patients with renal anemia before and after peritoneal dialysis initiation

Abstract

Background Serial management of renal anemia using continuous erythropoietin receptor activator (CERA) throughout the peritoneal dialysis initiation period has rarely been reported. We investigated the efficacy and dosage of CERA treatment from pre- to post-peritoneal dialysis initiation for anemia management in patients with end-stage renal disease. Methods Twenty-six patients (13 men; mean age 60.9 years) who started peritoneal dialysis between April 2012 and April 2018 were investigated. Serial changes in hemoglobin levels, transferrin saturation and ferritin levels, CERA dosage, and the erythropoietin resistance index (ERI) over a 48 week period were retrospectively examined. Results Mean hemoglobin levels increased significantly from 10.5 g/dL at 24 weeks prior to the peritoneal dialysis initiation to 11.5 g/dL at 4 weeks post-initiation. The proportion of patients with hemoglobin levels ≥ 11 g/dL increased significantly after peritoneal dialysis initiation. The mean CERA dosage was 57.0 µg/month at 24 weeks prior to dialysis initiation, 86.5 µg/month at initiation, and 72.0 µg/month at 4 weeks post-initiation. Thus, the dosage tended to increase immediately before peritoneal dialysis initiation and then decreased thereafter. Hemoglobin levels were significantly lower, while the CERA dosage for maintaining hemoglobin levels and ERI tended to be higher at dialysis initiation in patients with diabetes than in those without diabetes. Conclusion Treatment with CERA prior to and during the peritoneal dialysis initiation achieved fairly good anemia management in patients with and without diabetes. The CERA dosage could be reduced in patients without diabetes after dialysis initiation.

Effects of Roxadustat on the Anemia and Iron Metabolism of Patients Undergoing Peritoneal Dialysis

“…These findings suggest that roxadustat improves and stabilizes hemoglobin concentrations without requiring any increase in dose in peritoneal dialysis patients with anemia that had previously been treated with ESA in a real-world clinical setting. Serum ferritin and TSAT have been reported to increase in peritoneal dialysis patients with anemia who are treated with ESA as the duration of peritoneal dialysis increases (13), which has been attributed to the effects of pro-inflammatory cytokines, such as tumor necrosis factor-α and interleukin-1, and uremic toxins, including polyamines, as well as parathyroid hormone (14,15). Roxadustat has been reported to improve iron metabolism through multiple pathways.…”

“…Serum ferritin and TSAT have been reported to increase in peritoneal dialysis patients with anemia who are treated with ESA as the duration of peritoneal dialysis increases ( 13 ), which has been attributed to the effects of pro-inflammatory cytokines, such as tumor necrosis factor-α and interleukin-1, and uremic toxins, including polyamines, as well as parathyroid hormone ( 14 , 15 ). Roxadustat has been reported to improve iron metabolism through multiple pathways.…”

Restless Leg Syndrome in Hemodialysis Patients

“…Iron Dextran : anemia is one of the challenging complications for ESRD patients. Although Recombinant Erythropiotin Alpha (rhEPO) can increase hemoglobin levels, iron deficiency can still wear the response to rhEPO, which increases the importance of iron supplementation 125,126. In addition, the less the iron levels, the more the symptoms of RLS.…”

“…The possibility of long-term treatment with benzodiazepines needs to be addressed by further studies. Benzodiazepines have also shown a great value in decreasing hemodialysis-associated seizures, which is one of the most severe hemodialysis complications in younger patients 125,130…”

“…Although Recombinant Erythropiotin Alpha (rhEPO) can increase hemoglobin levels, iron deficiency can still wear the response to rhEPO, which increases the importance of iron supplementation. 125,126 In addition, the less the iron levels, the more the symptoms of RLS. Iron is involved in converting tyrosine to levodopa, which is decarboxylated to dopamine later, so iron is considered a rate-limiting step.…”