Kidney Week 2019 — Low, fixed-dose darbepoetin strategy limits the number of transfusions in chronic kidney disease


  • Marielle Fares, Pharm.D.
  • Conference Reports
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Takeaway

  • A low, fixed dose of darbepoetin with lower cumulative dose resulted in fewer red blood cell (RBC) transfusions than dose titration based on hemoglobin (Hb) levels.

Why this matters

  • Exposure to high doses of erythropoiesis-stimulating agents, high cumulative dose, Hb excursions, and rapid Hb rises may contribute to cardiovascular events.
  • The START-CKD trial explored the effect of a dose-limiting strategy on RBC transfusion.

Study design

  • Phase 3, multicenter, randomized, double-blind, parallel-group study (n=756) of 377 patients receiving titrated darbepoetin and 379 receiving a fixed dosing strategy for 2 years.
  • Anemic patients with chronic kidney disease (CKD) stage III-V received darbepoetin using fixed-dose darbepoetin of 0.45 μg/kg or Hb-titration dose algorithm.
  • The primary endpoint was the percentage of patients transfused; transfusions were performed as deemed necessary by the treating physician.

Key results

  • A total of 24.1% of patients were transfused in the fixed-dose and 24.4% in the titration-dose groups, with similar time to first transfusion (HR 1.01).
  • Average Hb achieved was greater in the titration-dose group as compared with the fixed-dose group (9.7 vs 9.4 g/dL).
  • The fixed-dose darbepoetin group had a lower average cumulative dose at 4 weeks than the titration dose (30.8 vs 50.7 μg/g).

Limitations

  • None stated.