Monthly continuous erythropoietin receptor activator versus weekly epoetin-beta, similar hemoglobinization but different anisocytosis degree in hemodialysis patients: a randomized controlled trial

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dc.contributor.author Uriol-Rivera, Miguel Giovanni
dc.contributor.author Obrador-Mulet, Aina
dc.contributor.author Jiménez-Mendoza, Sónia
dc.contributor.author Corral-Báez, Antonio
dc.contributor.author Periañez Párraga, Leonor
dc.contributor.author García-Álvarez, Ángel
dc.contributor.author de la Prada, Francisco Javier
dc.date.accessioned 2022-12-14T07:14:20Z
dc.date.available 2022-12-14T07:14:20Z
dc.identifier.uri http://hdl.handle.net/11201/159983
dc.description.abstract Background: The monthly continuous erythropoietin receptor activator (CERA) utilization maintains stable hemoglobin (Hb) after conversion from weekly epoetin-β (EB); however, how the different pharmacologic properties affect the red blood cell (RBC) size determined by RBC distribution width (RDW) has not been evaluated yet. We assess the potential differences in iron metabolism, plasma erythropoietin (EPO), hepcidin, and soluble α-Klotho (α-Klotho) levels as an emergent hematopoiesis factor. Methods: Thirty-seven chronic hemodialysis patients were included from January 2010 to November 2011 and randomized (1:1) to continue with EB or to convert to monthly CERA. Primary outcome was the mean change in Hb between groups at months 0, 3 and 6, and the percentage of patients who maintained stable Hb (Hb ± 1 g/dL from baseline level to month 6). Secondary outcomes were the influence on the erythropoietic process and iron metabolism markers. Thirty-one patients completed the study (CERA: n = 15, EB: n= 16). Results: The mean (95% confidence interval (CI)) Hb difference between groups was 0.28 g/dL (-0.36 to 0.93). There was no difference between the percentages of patients with stable Hb levels. In the CERA group RDW values increased progressively (interaction erythropoietin-stimulating agent (ESA) type and time on RDW values, F (1.57, 45.60) = 17.17, P < 0.01, partial η2 = 0.37) and the mean corpuscular volume changed at the different time points, (F (2,28) = 29.12, P = 0.03, partial η2 = 0.23). During the evaluation period, in the CERA group, EPO was higher, and hepcidin and ferritin decreased significantly. α-Klotho decreased in both groups and correlated negatively with the changes on the RDW and positively with transferrin and serum iron. The number of serious adverse events was higher at the CERA group. Conclusions: Monthly CERA maintained Hb concentrations; however, it showed a significant effect on RDW, probably due to its impact on the EPO and hepcidin levels. α-Klotho decreased significantly in both groups, and its changes correlated with the changes in iron metabolism. Whether the RDW evolution was associated with the serious adverse events (SAEs) is a feasible hypothesis that needs to be confirmed in large studies.
dc.format application/pdf
dc.relation.isformatof https://doi.org/10.14740/jh862
dc.relation.ispartof Journal of Hematology, 2021, vol. 10, num. 6, p. 255-265
dc.rights , 2021
dc.subject.classification Ciències de la salut
dc.subject.other Medical sciences
dc.title Monthly continuous erythropoietin receptor activator versus weekly epoetin-beta, similar hemoglobinization but different anisocytosis degree in hemodialysis patients: a randomized controlled trial
dc.type info:eu-repo/semantics/article
dc.date.updated 2022-12-14T07:14:21Z
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.identifier.doi https://doi.org/10.14740/jh862


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