Rottembourg J B, Bridges I, Pronai W, Feriani M, McMahon L P, De Meester J M J, Farouk M, Molemans B
Centre Suzanne Levy, Diaverum Group, Clinique du Mont Louis, Paris, France.
Clin Nephrol. 2011 Mar;75(3):242-50. doi: 10.5414/cn106749.
Erythropoiesis-stimulating agents (ESAs) are recommended for managing renal anemia. ALTERNATE is an observational study in European and Australian dialysis patients evaluating darbepoetin a (DA) once every 2 weeks (Q2W) in clinical practice.
Adult dialysis patients initiating treatment with DA Q2W were eligible regardless of previous/current ESA use. Data were collected 6 months before and 12 months after Q2W initiation. The primary endpoint was hemoglobin (Hb) concentration 12 months after initiation.
A total of 6,112 patients were enrolled; 6,104 were eligible (87% hemodialysis, 12% peritoneal dialysis). Before initiation, 77.3%, 8.8%, and 7.8% of patients were receiving DA, epoetin beta, and epoetin alpha, respectively; 6% were ESA naïve. Mean (95% CI) Hb (g/dl) was 11.68 (11.63-11.72) 6 months before initiation, 12.00 (11.97-12.04) at initiation, and 11.62 (11.58-11.66) 12 months after initiation. Geometric mean (95% CI) weekly ESA dose (µg/wk) was 27.27 (26.62-27.93) immediately before initiation, 23.69 (23.28 - 24.10) at initiation, and 26.80 (26.12-27.49) 12 months after initiation. At month 12, 77.3% of patients were receiving DA Q2W.
This large observational study demonstrates that Hb concentrations can be effectively maintained over 12 months in a general dialysis population with DA Q2W without an increase in ESA dose.
促红细胞生成素（ESAs）被推荐用于治疗肾性贫血。ALTERNATE是一项在欧洲和澳大利亚透析患者中进行的观察性研究，评估临床实践中每2周一次（Q2W）使用的促红细胞生成素α（DA）。
开始每2周一次使用DA治疗的成年透析患者符合条件，无论之前/当前是否使用ESAs。在开始每2周一次治疗前6个月和开始后12个月收集数据。主要终点是开始治疗12个月后的血红蛋白（Hb）浓度。
共纳入6112例患者；6104例符合条件（87%为血液透析，12%为腹膜透析）。开始治疗前，分别有77.3%、8.8%和7.8%的患者接受DA、促红细胞生成素β和促红细胞生成素α治疗；6%未使用过ESAs。开始治疗前6个月，平均（95%CI）Hb（g/dl）为11.68（11.63 - 11.72），开始治疗时为12.00（11.97 - 12.04），开始治疗后第12个月为11.62（11.58 - 11.66）。开始治疗前即刻，几何平均（95%CI）每周ESA剂量（μg/wk）为27.27（26.62 - 27.93），开始治疗时为23.69（23.28 - 24.10），开始治疗后第12个月为26.80（26.12 - 27.49）。在第12个月时，77.3%的患者每2周一次接受DA治疗。
这项大型观察性研究表明，在一般透析人群中，每2周一次使用DA可在12个月内有效维持Hb浓度，且ESA剂量无增加。
