Effects of Continuous Erythropoietin Receptor Activator (CERA) in Kidney Transplant Recipients

doi:10.1016/j.transproceed.2012.05.063

Transplantation Proceedings

Volume 44, Issue 7, September 2012, Pages 1916-1917

https://doi.org/10.1016/j.transproceed.2012.05.063 Get rights and content

Abstract

Erythropoietin-stimulating agents (ESAs) are commonly used to treat anemia in kidney transplant recipients (KTRs). Since 2007, continuous erythropoietin receptor activator (CERA) has been one of the newest recombinant ESAs to treat anemia in dialysis and nondialysis patients with chronic kidney disease. The efficacy of CERA to manage anemia has not been extensively evaluated in KTRs. We evaluated safety, efficacy, and satisfaction among KTRs treated with CERA. We enrolled 19 anemic KTRs (60 ± 9.3 y) who were treated with short-acting ESA for ≥24 weeks. They were shifted to the equivalent dose of CERA and followed for 24 weeks. We measured serum hemoglobin, hematocrit, creatinine, iron, ferritin, and transferrin. To investigate tolerance to and satisfaction with short-acting ESA and CERA, questionnaires were administered to the patients before shifting to CERA and at the end of the follow-up. After 6 months, CERA induced an increase in hemoglobin levels (12.3 ± 0.8 vs 11.2 ± 1.1 g/dL; P = .002, CERA vs short-acting ESA, respectively). In 2 patients treatment was discontinued because the hemoglobin increased to >13 g/dL. No significant differences were observed in serum iron and creatinine between short-acting ESA and CERA throughout the study. The questionnaires showed better compliance to CERA treatment with reduced pain at the injection site, which led subjects to prefer CERA to short-acting ESA. In summary, CERA showed better control of anemia compared with short-acting ESA. It was preferred by the majority of patients, mainly because of the reduced number of monthly injections. Our results demonstrated CERA to be effective, safe, and well tolerated in the management of anemia in KTRs.

Section snippets

Methods

We enrolled KTRs treated for posttransplant anemia with a short-acting ESA for ≥24 weeks. Exclusion criteria were recent blood transfusions, history of cancer, resistance to ESA, recent infection, and iron deficiency. Patients shifted to receive an equivalent dose of CERA were followed for 24 weeks. Serum hemoglobin levels, hematocrit, and glomerular filtration rate (GFR), as estimated by the CKD Epidemilogy Collaboration formula, were measured monthly. Every 3 months, we also measured serum

Results

We enrolled 19 KTRs including 12 men 7 women, of mean age 60 ± 9.3 years. The mean hemoglobin level was 11.2 ± 1.1 g/dL at the moment of the therapeutic shift. All patients reached target hemoglobin values after 12 weeks of treatment. In 2 patients treatment was discontinued because of high serum hemoglobin levels (>13 g/dL). In the other patients the mean CERA monthly dose of 150 ± 68 μg increased the hemoglobin levels similarly to the equivalent dose of a short-acting ESA: 12.3 ± 0.8 g/dL vs

Discussion

Anemia is an important complication of kidney transplantation that often requires treatment with ESAs. Unfortunately, because ESA treatment may be ineffective at the usually prescribed dosage that manages this complication in CKD patients, it may be necessary to increase the ESA dosage. Short-acting ESA treatment requires frequent injections, which may be several per week. In contrast CERA, a new erythropoietin, can be administered once monthly. In an earlier study, Macdougall et al

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W.C. Winkelmayer et al.
Pottransplantation anemia: management and rationale
Clin J Am Soc Nephrol
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Renal transplantationComplicationsEffects of Continuous Erythropoietin Receptor Activator (CERA) in Kidney Transplant Recipients

Abstract

Section snippets

Methods

Results

Discussion

Transplant Proc

Pottransplantation anemia: management and rationale

Clin J Am Soc Nephrol

Renal transplantation
Complications
Effects of Continuous Erythropoietin Receptor Activator (CERA) in Kidney Transplant Recipients