Conversion from Epoetin and Darbepoetin to C.E.R.A. in Non-Dialysis CKD Patients: A Multicenter Italian Prospective Study in Nephrology Practice

Background: In non-dialysis patients (ND-CKD), C.E.R.A. has been extensively investigated in ESA-naïve subjects but no data are available on its efficacy after switch from other ESA. Methods: In this prospective, multicenter, open-label study lasting 24 weeks, ND-CKD patients (n = 157) receiving ESA were converted to C.E.R.A. at doses lower than recommend- ed. Primary outcome was the prevalence of Hb target (11– 12.5 g/dl). Results: Age was 73 ± 13 years and GFR was 26.2 ± 9.4 ml/min/1.73 m2; male gender, diabetes and prior cardio- vascular disease were 49, 33 and 19%, respectively. Doses of darbepoetin (25 ± 16 μg/week, n = 124) and epoetin (5,702 ± 3,190 IU/week, n = 33) were switched to low dose C.E.R.A. (87 ± 17 μg/month). During the study, prevalence of Hb tar- get increased from 60% to 68% at week-24, while that of Hb < 11 g/dl declined from 32% to 16% (p < 0.001). Hb in- creased from 11.3 ± 0.8 at baseline to 11.7 ± 0.9 g/dl at week- 24 (p = 0.01) without changes in C.E.R.A. dose. Significant predictors of Hb increase were low BMI, low Hb and longer dosing intervals before switch. These factors also predicted the risk of Hb overshooting (Hb > 12.5 g/dl) occurring in 57 patients. Conclusions: In ND-CKD, conversion from other ESAs to C.E.R.A. is associated with a better anemia control induced by a greater Hb increase in patients previously treat- ed with ESAs at extended dosing interval. This parameter should be considered when switching to long-acting ESA for its potential impact on the risk of overshooting.