Abstract: SA-PO231
Long-Acting Erythropoiesis-Stimulating Agent (ESA) Induced the Physiological Erythropoiesis via an Improvement of Iron Availability
Session Information
- Anemia and Iron Metabolism: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 202 Anemia and Iron Metabolism: Clinical
Author
- Kuragano, Takahiro, Internal Medicine Division of Kidney and Dialysis, Nishinomiya, Japan
Background
Maintenance hemodialysis (MHD) patients with a dysutilization of iron for erythropoiesis exhibited significantly higher risks of cardiovascular disease and all-cause death compared to other groups. Thus, anemia treatment that improves iron availability for erythropoiesis might attenuate the risk of adverse events of these patients. Recently, basic studies or short-term clinical studies reported that the long-acting erythropoiesis-stimulating agent (ESA) significantly suppressed the expression of hepcidin, which regulates iron availability. In this study, we compared the iron availability for erythropoiesis between short- and long-acting ESA during a long-term period.
Methods
Sixty-nine MHD patients with renal anemia (mean age: 69 yo, % of male: 65%, mean duration of HD time: 122±98 months) were enrolled in this study. All patients were treated with a short-acting ESA (epoetinα or epoetinβ) for the first 30 months (short-acting ESA period). Then, all patients were switched to a longacting ESA (continuous erythropoietin receptor activator-methoxy polyethylene glycol-epoetin beta) for the next 30 months (long-acting ESA period).
Results
The mean dose of the short-acting ESA and longacting ESA was 2795±259 IU/week and 82.6±14.7 μg/month, respectively.
Compared with the short-acting ESA period, the mean Hb (10.3±0.2 vs.10.6±0.2 g/dL) and TSAT (15±2.9 vs. 25.9±3.5%) levels were significantly (p<0.05) increased in the long-acting ESA period. Additionally, the mean serum ferritin level (72.0±22.2 vs. 56.3±14.0 ng/mL) and the dose of IV iron (108.0±63.7 vs. 53.4±26.9 mg/month) were significantly (p<0.05) decreased in the long-acting ESA period.
Conclusion
In this study, anemia treatment of MHD patients with a long-acting ESA attenuated iron utilization for erythropoiesis (decreased serum ferritin and increased TSAT) and maintained target Hb levels without a higher dose of IV iron and ESA. From these results, we hypothesize that anemia treatment with a longacting ESA might induce more physiological erythropoiesis in MHD patients via improvements in iron metabolism compared to treatment with a short-acting ESA. To evaluate the effect of the long-acting ESA on the adverse events or survival of MHD patients, further randomized control studies are needed.