Treating Anemia in Patients on Hemodialysis

In patients with chronic kidney disease (CKD) and receiving dialysis, treatment with hypoxia-inducible factor prolyl hydroxylase inhibitors improves anemia. Those agents are approved for anemia treatment in CKD and dialysis patients in Japan.

Shoichiro Daimon, MD, and colleagues provided a case report of an 89-year-old man with anemia who was receiving maintenance hemodialysis [CEN Case Reports. doi.org/10.1007/s13730-022-00706-1]. The patient was treated successfully for anemia with a dose-up of darbepoetin alfa from 10 to 20 µg per week; the dose was gradually tapered to 5 µg.

Subsequently, serum hemoglobin levels decreased with newly occurring sustained inflammation and left pleural effusion of an unknown cause. The darbepoetin alfa dose was increased to 20 ug per week, which was not effective. Darbepoetin alfa was switched to 4 mg of daprodustat daily, which was minimally effective under sustained inflammation, with serum hemoglobin levels maintained. The increase in hemoglobin levels was attributed to the increase in the number of red blood cells, not the mean corpuscular hemoglobin level.

Despite the contrasting effect on anemia by the 20 µg of weekly darbepoetin alfa and daily 4 mg of daprodustat, during the inflammatory state the reticulocyte counts were equivalent. The serum erythropoietin levels during administration of daprodustat were within the physiologic range (8.5-18.8 mIU/mL).

In summary, the authors said, “For anemia treatment in hemodialysis patients, daprodustat is less influenced by the inflammatory status than darbepoetin alfa, and one of the possible reasons for this includes the extended red blood cell lifespan.”