Efficacy of continuous erythropoietin receptor activator for end-stage renal disease patients with renal anemia before a
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ORIGINAL ARTICLE
Efficacy of continuous erythropoietin receptor activator for end‑stage renal disease patients with renal anemia before and after peritoneal dialysis initiation Daisuke Fujimoto1 · Masataka Adachi1 · Yoshikazu Miyasato1 · Yusuke Hata1 · Hideki Inoue1 · Akira Oda1 · Yutaka Kakizoe1 · Terumasa Nakagawa1 · Akiko Shimasaki1 · Keishi Nakamura1 · Yu Nagayoshi1 · Masashi Mukoyama1 Received: 5 March 2020 / Accepted: 15 September 2020 © The Author(s) 2020
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. Keywords Continuous erythropoietin receptor activator (CERA) · Diabetes mellitus · Erythropoietin resistance index (ERI) · Peritoneal dialysis · Renal anemia
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10157-020-01973-x) contains supplementary material, which is available to authorized users. * Masataka Adachi m‑[email protected]‑u.ac.jp 1
Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, 1‑1‑1 Honjo, Chuo‑ku, Kumamoto 860‑8556, Japan
Anemia is an almost inevitable complication of end-stage renal disease (ESRD) due to the inadequate production of endogenous erythropoietin by the impaired kidneys [1]. Renal anemia is significantly associated with cardiovascular events and all-cause mortality [2, 3]. Erythropoiesis-stimulating agents (ESAs) improve not o
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