Abstract: TH-PO969
Conversion from Darbepoetin Alfa to Epoetin Alfa in a Multi-Center Cohort of In-Center Hemodialysis Patients
Session Information
- Anemia in CKD: Risk Factors, Practice Patterns, Therapies
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Green, Gopa B., Satellite Healthcare, San Jose, California, United States
- Doss-McQuitty, Sheila, Satellite Healthcare, San Jose, California, United States
- Shang, Dongyang, Satellite Healthcare, San Jose, California, United States
- Chang, Steven, Xelay Acumen, San Mateo, California, United States
- Yang, Alex, Xelay Acumen, San Mateo, California, United States
- Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
Background
Over the past two decades of anemia treatment, many dialysis patients have been converted from a short-acting erythropoiesis-stimulating agent (ESA) to a long-acting ESA. However, there is little data about conversion of a population in the opposite manner, from a long-acting ESA to a short-acting ESA. We investigated the initial results of conversion of a population of in-center hemodialysis patients from darbepoetin alfa to epoetin alfa in early 2023.
Methods
During January and February 2023, 69 outpatient hemodialysis centers at Satellite Healthcare converted from first-line anemia treatment with darbepoetin alfa (Aranesp) to treatment with epoetin alfa (Epogen). Patients were converted according to a protocol-based dosing algorithm derived from the Aranesp package insert and published studies. To assess changes in anemia-related parameters before and after conversion, we analyzed hemoglobin, ESA dose, transferrin saturation, and ferritin in patients who completed ≥4 hemodialysis treatments during a 2-week period of each month from July 2022 to April 2023; the period comprised the prescheduled week of blood draws and the week thereafter.
Results
On average, monthly cohorts included 6633 patients, among whom 6193 (93.4%) completed ≥4 treatments during the 2-week observation period. In 2022, 5.0% of ESA-treated patients received epoetin alfa, 94.8% received darbepoetin alfa, and 0.2% received both agents. In February 2023, 99.3% of ESA-treated patients received epoetin alfa, 0.4% received darbepoetin alfa, and 0.3% received both agents; by April, 99.6% received epoetin alfa. The distribution of hemoglobin was stable during and after the conversion process (table). The ratio of mean weekly epoetin alfa dose (IU) in February 2023 to darbepoetin alfa dose (mcg) in 2022 was 309; from February to April, mean weekly epoetin alfa dose decreased 3%. From December 2022 to March 2023, distributions of transferrin saturation and ferritin shifted modestly downward.
Conclusion
A protocol-based ESA dosing algorithm can be used to convert in-center hemodialysis patients from darbepoetin alfa to epoetin alfa in a short timeframe, without disruption of the hemoglobin distribution.