Matthew Weir, MD: Darbepoetin Reduces Risk of Red Blood Cell Transfusions for CKD Patients

There is a well-known link between cardiovascular events and exposure to high doses of erythropoiesis stimulating agents (ESA), high cumulative doses, wide hemoglobin excursions, and a rapid increase in hemoglobin in patients with chronic kidney disease (CKD).

However, in the START-CKD (Strategies Using Darbepoetin Alfa to Avoid Transfusions in CKD) trial, investigators found that minimizing red blood cell transfusion can be achieved using a low fixed-dose of darbepoetin with lower cumulative dose than use of hemoglobin-based dose titration approach to produce better patient outcomes.

During the American Society of Nephrology (ASN) Kidney Week in Washington, D.C., Matthew Weir, MD, director of the Division of Nephrology in the Department of Medicine at the University of Maryland Hospital, explained how the START-CKD trial will help patients.

MD Magazine: On the START-CKD trial.

Weir: The START-CKD trial is a very innovative and interesting way to evaluate optimal strategies for ESA administration in people receiving chronic dialysis.

Obviously, we want to give enough but not too much. So, what we did was we designed a prospective, randomized, controlled trial to actually give people on dialysis who are iron replete low-dose, fixed doses of darbepoetin compared to traditional physician based adjustments in darbepoetin over a period of 6-months.

Then what we wanted to do was to evaluate the cumulative effect of the different ESA administration patterns, not only on hemoglobin but on the ultimate risk for requiring red blood cell transfusions.

The unique part of the study was that we had all hospitalizations and events carefully adjudicated. So, it really provides some important granularity about opportunities for optimal ESA dosing patterns in patients on dialysis.

The results basically demonstrated that a low fixed dose of darbepoetin was every bit as effective in controlling hemoglobin levels and reducing the risk for transfusions compared to a physician adjusted dose.

Interestingly, we were able to use significantly less darbepoetin enduring the course of the study to control hemoglobin levels.

So, it illustrates the fact that really there may be easier strategies for maintaining hemoglobin levels and avoiding transfusion patients a transfusion in patients simply by adjusting, giving low dose darbepoetin in to the patients.