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Uriol-Rivera MG, Obrador-Mulet A, Jimenez-Mendoza S, Corral-Baez A, Perianez-Parraga L, Garcia-Alvarez A, de la Prada FJ. Monthly Continuous Erythropoietin Receptor Activator Versus Weekly Epoetin-Beta, Similar Hemoglobinization but Different Anisocytosis Degree in Hemodialysis Patients: A Randomized Controlled Trial. J Hematol 2022; 10:255-265. [PMID: 35059087 PMCID: PMC8734489 DOI: 10.14740/jh862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 12/27/2022] Open
Abstract
Background The monthly continuous erythropoietin receptor activator (CERA) utilization maintains stable hemoglobin (Hb) after conversion from weekly epoetin-β (EB); however, how the different pharmacologic properties affect the red blood cell (RBC) size determined by RBC distribution width (RDW) has not been evaluated yet. We assess the potential differences in iron metabolism, plasma erythropoietin (EPO), hepcidin, and soluble α-Klotho (α-Klotho) levels as an emergent hematopoiesis factor. Methods Thirty-seven chronic hemodialysis patients were included from January 2010 to November 2011 and randomized (1:1) to continue with EB or to convert to monthly CERA. Primary outcome was the mean change in Hb between groups at months 0, 3 and 6, and the percentage of patients who maintained stable Hb (Hb ± 1 g/dL from baseline level to month 6). Secondary outcomes were the influence on the erythropoietic process and iron metabolism markers. Thirty-one patients completed the study (CERA: n = 15, EB: n = 16). Results The mean (95% confidence interval (CI)) Hb difference between groups was 0.28 g/dL (-0.36 to 0.93). There was no difference between the percentages of patients with stable Hb levels. In the CERA group RDW values increased progressively (interaction erythropoietin-stimulating agent (ESA) type and time on RDW values, F (1.57, 45.60) = 17.17, P < 0.01, partial η2 = 0.37) and the mean corpuscular volume changed at the different time points, (F (2, 28) = 29.12, P = 0.03, partial η2 = 0.23). During the evaluation period, in the CERA group, EPO was higher, and hepcidin and ferritin decreased significantly. α-Klotho decreased in both groups and correlated negatively with the changes on the RDW and positively with transferrin and serum iron. The number of serious adverse events was higher at the CERA group. Conclusions Monthly CERA maintained Hb concentrations; however, it showed a significant effect on RDW, probably due to its impact on the EPO and hepcidin levels. α-Klotho decreased significantly in both groups, and its changes correlated with the changes in iron metabolism. Whether the RDW evolution was associated with the serious adverse events (SAEs) is a feasible hypothesis that needs to be confirmed in large studies.
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Affiliation(s)
- Miguel G Uriol-Rivera
- Nephrology Department, Hospital Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Aina Obrador-Mulet
- Nephrology Department, Hospital Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Sonia Jimenez-Mendoza
- Nephrology Department, Hospital Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Antonio Corral-Baez
- Nephrology Department, Policlinica Miramar-Hospital Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | | | - Angel Garcia-Alvarez
- Pharmacy Department, Hospital Son Espases, Palma de Mallorca, Balearic Islands, Spain
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Long-acting erythropoiesis-stimulating agent (ESA) induces physiological erythropoiesis via improvement of iron availability. Int Urol Nephrol 2021; 54:1079-1084. [PMID: 34390438 DOI: 10.1007/s11255-021-02965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies reported that the long-acting erythropoiesis-stimulating agent (ESA) significantly suppresses the expression of hepcidin, which regulates iron availability. In this study, we compared the iron availability for erythropoiesis between short and long-acting ESA over a long period. METHODS We enrolled 69 hemodialysis patients in this study. All patients were treated with short-acting ESA (epoetin-α or epoetin-β) for the first 30 months. Then, all patients switched to long-acting ESA (continuous erythropoietin receptor activator-methoxy polyethylene glycol-epoetin beta) for the next 30 months. We measured their blood levels of Hb, ferritin, iron, total iron-binding capacity, intact-parathyroid hormone, calcium, phosphate, albumin, and highly sensitive CRP level. RESULTS There was no significant change in the dose of short or long-acting ESA during the study period. Compared with the short-acting ESA period, the mean hemoglobin (Hb) and transferrin saturation levels were significantly increased in the long-acting ESA period (from 10.3 ± 0.2 to 10.6 ± 0.3 g/dL). On the other hand, the mean serum ferritin level (from 72 ± 22.2 to 56.3 ± 14 ng/mL) and the dose of IV iron (from 108 ± 63 to 53 ± 27 mg/month) were significantly decreased in the long-acting ESA period. CONCLUSION In this study, we found that anemia treatment with long-acting ESA attenuated the iron utilization for erythropoiesis and maintained target Hb levels without requiring a higher dose of IV iron or ESA.
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Sato K, Taniai M, Kato K, Kato T. Relationship between the Induced Iron Overload Model and Hepatic Erythropoiesis in Xenopus laevis. Zoolog Sci 2020; 37:61-69. [DOI: 10.2108/zs190102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/29/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Kei Sato
- Faculty of Education and Integrated Arts and Sciences, Waseda University, 2-2 Wakamatsu-Cho, Shinjuku-ku, Tokyo 162-8480, Japan
| | - Masamitsu Taniai
- Major in Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 2-2 Wakamatsu-Cho, Shinjuku-ku, Tokyo 162-8480, Japan
| | - Kota Kato
- Major in Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 2-2 Wakamatsu-Cho, Shinjuku-ku, Tokyo 162-8480, Japan
| | - Takashi Kato
- Faculty of Education and Integrated Arts and Sciences, Waseda University, 2-2 Wakamatsu-Cho, Shinjuku-ku, Tokyo 162-8480, Japan
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2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0114-y] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Matsuo-Tezuka Y, Noguchi-Sasaki M, Kurasawa M, Yorozu K, Shimonaka Y. The effect of frequency of C.E.R.A. administration on the contribution of dietary iron for erythropoiesis. Int J Hematol 2017; 106:60-70. [DOI: 10.1007/s12185-017-2215-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 02/08/2023]
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Matsuo-Tezuka Y, Noguchi-Sasaki M, Kurasawa M, Yorozu K, Shimonaka Y. Quantitative analysis of dietary iron utilization for erythropoiesis in response to body iron status. Exp Hematol 2016; 44:491-501. [PMID: 26911670 DOI: 10.1016/j.exphem.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/18/2022]
Abstract
Erythropoiesis requires large amounts of iron for hemoglobin synthesis. There are two sources of iron for erythropoiesis, dietary and stored iron; however, their relative contributions to erythropoiesis remain unknown. In this study, we used the stable iron isotope (57)Fe to quantify synthesis of hemoglobin derived from dietary iron. Using this method, we investigated the activities of dietary iron absorption and the utilization of dietary iron for erythropoiesis in responses to stimulated erythropoiesis and to interventions to alter body iron status. Under iron-loaded conditions, the activity of dietary iron absorption was clearly lowered in response to up-regulation of hepcidin, although the estimated activity of iron release from stored iron was not compared with that under control conditions. This result was supported by the observation that two duodenal iron transporters, divalent metal transporter 1 (DMT1) and ferroportin, were downregulated by iron loading, although the levels of expression of ferroportin in iron storage tissues were not changed by iron loading under erythropoietic stimulation by epoetin-β pegol (C.E.R.A., a long-acting erythropoiesis-stimulating agent). These results indicate that the dietary iron absorption system is more sensitive to body iron status than are reticuloendothelial iron- release mechanisms. Our data indicated that there could be a regulatory mechanism favoring use of stored iron over dietary iron under iron-loaded conditions.
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Affiliation(s)
- Yukari Matsuo-Tezuka
- Product Research Department, Chugai Pharmaceutical Company, Ltd., Kamakura, Japan.
| | | | - Mitsue Kurasawa
- Product Research Department, Chugai Pharmaceutical Company, Ltd., Kamakura, Japan
| | - Keigo Yorozu
- Product Research Department, Chugai Pharmaceutical Company, Ltd., Kamakura, Japan
| | - Yasushi Shimonaka
- Product Research Department, Chugai Pharmaceutical Company, Ltd., Kamakura, Japan
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Noguchi-Sasaki M, Sasaki Y, Matsuo-Tezuka Y, Yasuno H, Kurasawa M, Yorozu K, Shimonaka Y. Reduction of a marker of oxidative stress with enhancement of iron utilization by erythropoiesis activation following epoetin beta pegol administration in iron-loaded db/db mice. Int J Hematol 2016; 103:262-73. [PMID: 26739261 DOI: 10.1007/s12185-015-1929-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED Iron, an essential element for various biological processes, can induce oxidative stress. We hypothesized that iron utilization for erythropoiesis, stimulated by epoetin beta pegol (C.E.R.A.), a long-acting erythropoiesis-stimulating agent, contributes to the reduction of iron-induced oxidative stress. We first investigated the sensitivity of several biomarkers to detect oxidative stress in mice by altering the amount of total body iron; we then investigated whether C.E.R.A. ameliorated oxidative stress through enhanced iron utilization. We treated db/db mice with intravenous iron-dextran and evaluated several biomarkers of iron-induced oxidative stress. In mice loaded with 5 mg/head iron, hepatic iron content was elevated and the oxidative stress marker d-ROMs (serum derivatives of reactive oxygen metabolites) was increased, whereas urinary 8-hydroxy-2'-deoxyguanosine and serum malondialdehyde were not, indicating that d-ROMs is a sensitive marker of iron-induced oxidative stress. To investigate whether C.E.R.A. ameliorated oxidative stress, db/db mice were intravenously administered iron-dextran or dextran only, followed by C.E.R.A. Hemoglobin level increased, while hepatic iron content decreased after C.E.R.A. TREATMENT Serum d-ROMs decreased after C.E.R.A. treatment in the iron-dextran-treated group. Our results suggest that C.E.R.A. promotes iron utilization for erythropoiesis through mobilization of hepatic iron storage, leading to a decrease in serum oxidative stress markers in iron-loaded db/db mice.
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Affiliation(s)
- Mariko Noguchi-Sasaki
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan.
| | - Yusuke Sasaki
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Yukari Matsuo-Tezuka
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Hideyuki Yasuno
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Mitsue Kurasawa
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Keigo Yorozu
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Yasushi Shimonaka
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
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Koibuchi K, Miyagi M, Arai T, Aoki T, Aikawa A, Sakai K. Comparing the efficacy of continuous erythropoietin receptor activator and darbepoetin Alfa treatments in Japanese patients with chronic kidney disease during the predialysis period: A propensity-matched analysis. Nephrology (Carlton) 2015; 20 Suppl 4:22-8. [DOI: 10.1111/nep.12641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Kiyoto Koibuchi
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Moriatsu Miyagi
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Taichi Arai
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Toshiyuki Aoki
- Department of Nephrology and Dialysis; Saiseikai Yokohama-City Eastern Hospital; Kanagawa Japan
| | - Atsushi Aikawa
- Department of Nephrology, School of Medicine, Faculty of Medicine; Toho University; Tokyo Japan
| | - Ken Sakai
- Department of Nephrology, School of Medicine, Faculty of Medicine; Toho University; Tokyo Japan
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Schmid H. Methoxy polyethylene glycol-epoetin beta for the treatment of anemia associated with chronic renal failure. Expert Rev Hematol 2015; 9:5-20. [PMID: 26573694 DOI: 10.1586/17474086.2016.1112734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since more than two decades erythropoiesis-stimulating agents are the main pillar for treatment of anemia associated with chronic kidney disease. Methoxy polyethylene glycol-epoetin beta (MPG-EPO), also called continuous erythropoietin receptor activator, is the longest acting erythropoiesis-stimulating agent currently available. MPG-EPO is characterized by an elimination half-life of approximately 137 h and offers extended dosing intervals up to 4 weeks. Numerous phase I/II studies and a comprehensive clinical phase III program demonstrated the feasibility of MPG-EPO therapy for anemia correction and maintenance of stable hemoglobin levels in adult chronic kidney disease patients. Due to patent disputes MPG-EPO was only available outside the US market so far. In view of a prevailing US market introduction, this review focuses on efficacy and safety data from pivotal trials, summarizes recent clinical research and finally tries to substantiate potential benefits associated with the use of this anti-anemic drug.
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Affiliation(s)
- Holger Schmid
- a Clinic and Policlinic IV, Section of Nephrology , Munich University Hospital , Munich , Germany.,b KFH Nierenzentrum Muenchen Laim , Munich , Germany
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Kuwahara M, Arai Y, Takehara E, Sasaki Y, Yoshimine T, Kusaka K, Shikuma S, Akita W, Uchida S. Early response to erythropoiesis-stimulating agents in non-dialysis chronic kidney disease patients. Clin Exp Nephrol 2015; 20:585-594. [PMID: 26511877 DOI: 10.1007/s10157-015-1188-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Renal anemia complicated with chronic kidney disease is usually treated with erythropoiesis-stimulating agents (ESAs). However, few studies have compared the early response of hemoglobin (Hb) to different kinds of ESAs. METHODS The effects of three types of ESAs-epoetin alfa or beta (EPO), darbepoetin alfa (DPO), and epoetin beta pegol (EPObp)-on renal anemia were followed in 416 pre-dialysis chronic kidney disease (CKD) patients. After the initial 12-week administration of ESAs, ΔHb/ESA dose/kg was calculated as an index of efficacy of each ESA. Furthermore, independent variables associated with ΔHb/ESA dose/kg (dependent variable) were determined using multiple linear regression analysis. The ten independent variables selected for analysis were: presence of diabetic nephropathy, estimated glomerular filtration rate (eGFR), Hb, albumin, iron (Fe), transferrin saturation (TSAT), ferritin, phosphate (P), intact parathyroid hormone (iPTH), and C-reactive protein. RESULTS The efficacy of DPO and EPObp were similar and higher than EPO. TSAT was most strongly correlated with ΔHb/EPO dose/kg in all three types of ESAs. Other significant independent factors were Hb, albumin, P, iPTH, and diabetic nephropathy in the EPO group, eGFR in the DPO group, and Fe in the EPObp group. The adjusted coefficient of determination (R (2)) ranged from 0.415 to 0.520 in the three ESA groups. CONCLUSIONS The study results suggest that TSAT is the best predictor of the initial 12-week responsiveness to ESA, irrespective of the type. Variables not investigated in this study also affect responsiveness to ESA in Japanese pre-dialysis CKD patients.
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Affiliation(s)
- Michio Kuwahara
- Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan.
| | - Youhei Arai
- Department of Nephrology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Eriko Takehara
- Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan
| | - Yasunori Sasaki
- Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan
| | - Tomoharu Yoshimine
- Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan
| | - Keita Kusaka
- Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan
| | - Satomi Shikuma
- Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan
| | - Wataru Akita
- Department of Nephrology, Shuuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama, 344-0035, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Washida N, Inoue S, Kasai T, Shinozuka K, Hosoya K, Morimoto K, Wakino S, Hayashi K, Itoh H. Impact of Switching From Darbepoetin Alfa to Epoetin Beta Pegol on Iron Utilization and Blood Pressure in Peritoneal Dialysis Patients. Ther Apher Dial 2015; 19:450-6. [DOI: 10.1111/1744-9987.12306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Naoki Washida
- Department of Endocrinology, Metabolism and Nephrology; Keio University School of Medicine; Tokyo Japan
| | - Shuji Inoue
- Department of Nephrology; Saitama Medical Center; Saitama Japan
| | - Takahiro Kasai
- Department of Endocrinology, Metabolism and Nephrology; Keio University School of Medicine; Tokyo Japan
| | - Keisuke Shinozuka
- Department of Endocrinology, Metabolism and Nephrology; Keio University School of Medicine; Tokyo Japan
| | - Koji Hosoya
- Department of Nephrology; Saiseikai Central Hospital; Tokyo Japan
| | - Kohkichi Morimoto
- Department of Endocrinology, Metabolism and Nephrology; Keio University School of Medicine; Tokyo Japan
| | - Shu Wakino
- Department of Endocrinology, Metabolism and Nephrology; Keio University School of Medicine; Tokyo Japan
| | - Koichi Hayashi
- Department of Endocrinology, Metabolism and Nephrology; Keio University School of Medicine; Tokyo Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology; Keio University School of Medicine; Tokyo Japan
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