Arrieta Javier, Moina Iñigo, Molina José, Gallardo Isabel, Muñiz María Luisa, Robledo Carmen, García Oscar, Vidaur Fernando, Muñoz Rosa Inés, Iribar Izaskun, Aguirre Román, Maza Antonio
Hospital de Basurto, Bilbao, Spain.
Hospital de Donostia, Donostia-San Sebastián, Spain.
Int J Nephrol Renovasc Dis. 2014 Oct 9;7:353-9. doi: 10.2147/IJNRD.S61895. eCollection 2014.
The objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa.
This was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline.
We included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months -12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P<0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P<0.0001). The conversion rate was 354:1 in patients requiring high (>200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses.
In patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. To maintain Hb stability, a conversion rate of 300:1 seems to be appropriate for most patients receiving low doses of epoetin alfa (≤200 IU/kg/week), while 350:1 would be better for patients receiving higher doses.
本文报道的研究目的是描述一组未经挑选的血液透析患者从促红细胞生成素α转换为达贝泊汀α时的剂量等效性和血红蛋白（Hb）稳定性。
这是一项多中心、观察性、回顾性研究，研究对象为年龄≥18岁且于2007年10月（第0个月）从静脉注射促红细胞生成素α转换为静脉注射达贝泊汀α并继续进行血液透析至少24个月的患者。调整剂量以将Hb维持在基线水平±1.0 g/dL范围内。
我们纳入了125例患者（男性占59.7%，平均[标准差（SD）]年龄70.4 [13.4]岁）。未观察到Hb水平有显著变化（分别在第-12、0、12和24个月时，平均[SD]为11.9 [1.3] g/dL、12.0 [1.5] g/dL、12.0 [1.5] g/dL和12.0 [1.7] g/dL，P = 0.409）。转换后，促红细胞生成素刺激剂（ESA）剂量显著降低（P < 0.0001），促红细胞生成素的年平均剂量为174.7（88.7）国际单位（IU）/kg/周，而达贝泊汀为95.7（43.4）（第一年）和91.4（42.7）IU/kg/周（第二年）（分别降低65%和64%）。ESA抵抗指数从促红细胞生成素时的15.1（8.5）IU/kg/周/g/dL降至达贝泊汀时的8.1（3.9）（第一年）和7.9（4.0）（第二年）（P < 0.0001）。对于需要高剂量（>200 IU/kg/周）促红细胞生成素的患者，转换率为354:1；对于需要低剂量的患者，转换率为291:1。
在接受ESA的血液透析患者中，从促红细胞生成素α转换为达贝泊汀α与所需剂量持续减少约65%相关。为维持Hb稳定性，对于大多数接受低剂量促红细胞生成素α（≤200 IU/kg/周）的患者，300:1的转换率似乎合适，而对于接受高剂量的患者，350:1的转换率可能更好。
