Aim: In this study, we investigated the efficacy and safety of conversion
of stable hemodialysis patients from the current short-acting r-HuEPO
(EPO beta) to the long-acting darbepoetin.
Method: The study included 12 months of darbepoetin administration.
The mean initial conversion ratio was 350 IU of short acting r-HuEPO
to 1 microgram of darbepoetin. We adjusted the dose of darbepoetin
to maintain hemoglobin levels between 11-12 g/dL. The study was
carried out on 2 consecutive phases of 12 weeks each. Success with
the extended dosing interval was defined as maintenance of mean
hemoglobin >10.0 g/dl during each phase.
Result: There were 26 patients who fulfilled the entry criteria.
Their mean age was 47.0 ± 17.13 years, and the mean duration on
hemodialysis was 55.8 ± 14.0 months. The mean weekly dose increased
from 28.75 ± 4.2 μg in the biweekly frequency of dosing to 38.5±3.9
μg after switching to the monthly protocol. The hemoglobin levels
were maintained at therapeutic range without statistically significant
change throughout the study; the mean hemoglobin levels was 10.81±
.86 g/L at start of the study and 10.86 ± .76 g/L at the end of 6 months.
Continuing the darbepoetin in 12 patients for one year disclosed no
significant change of the conversion ratio of the drug, and the mean
of hemoglobin levels remained within the targeted limits.
Conclusion: Darbepoetin alpha is effective and safe for the treatment
of anemia in hemodialysis patients even at monthly dose intervals
and for long-term. With the the above mentioned conversion ratio
and current prices, darbepoetin seems more expensive than the short
acting erythropoetin beta by 15%, 58 % for the biweekly and monthly
doses respectively. However, the longer dosing intervals are certainly
much better convenience to patients and care takers in comparison
with the currently used short acting ESAs.