Initiation of darbepoetin for management of anemia in non-dialysis-dependent patients with chronic kidney disease.

The anemia of chronic kidney disease (CKD) is a common comorbidity seen in kidney diseases. It is also associated with increased cardiovascular morbidity and mortality and diminished quality of life. Often, patients with CKD of different stages require erythropoiesis-stimulating agents (ESAs) to maintain their hemoglobin (Hb) within the target range. Darbepoetin alfa is a newer ESA with a longer half-life than recombinant human erythropoietin (EPO). The objective of this study is to assess the efficacy and safety profile of twice-monthly (Q2W) and once a month (1QM) darbepoetin alfa in CKD patients, not on dialysis. The secondary objective was to assess the appropriate dose conversion from EPO to darbepoetin. Patients with CKD not on dialysis, receiving darbepoetin alfa every other week, or once every month, and with stable Hb levels between 10 and 12 g/dL, were enrolled in this single-center, open-label, single-arm study. In this study, 36 patients (21 female, 15 male) were enrolled with a mean age of 46.4 ± 20.12 years. About 56% of the patients (n = 20) received darbepoetin alfa 40 μg Q2W for more than three months and 36% (n = 13) were on once-monthly doses, whereas the other 8% (n = 3) were on variable doses ranging from 20 to 60 μg every two weeks. More than 80% of the patients were converted from short-acting EPO to darbepoetin corresponding to a conversion ratio of 672.2 IU:1 μg (standard deviation = 488.5). Hb levels ≥10 g/dL were maintained in 77.78% of the patients. The safety profile of darbepoetin alfa in this study was recorded, and no significant adverse effects were noted. Our study suggests that darbepoetin alfa, administered in fixed small doses and frequency of Q2W or Q1M, maintained Hb levels ≥10 g/dL in patients with CKD, not on dialysis.