STOCKHOLM—Whether darbepoetin alfa (DA) is administered in the middle or at the end of a hemodialysis session has no significant effect on hemoglobin levels, according to a French study.
Some in vitro studies have suggested the possibility of partial adsorption of erythropoiesis-stimulating agents in dialysis membranes and lines, but whether this occurs in the clinical setting has not been confirmed.
Researchers at the Mont Louis Clinic in Paris and the Es/CSD in Boulogne-Billancourt enrolled 90 hemodialysis patients in a 12-month crossover trial. The patients received IV DA once every two weeks for six months administered either in the middle or at the end of the hemodialysis.
After six months, patients were switched to the other injection time for an additional six months. Fourteen patients discontinued the study. Only patients with a hemoglobin value at baseline and at month 6 for at least one of the two study periods were considered evaluable and included in the analysis. At the end of the study, the evaluable patients included 71 in the end-of-session group and 70 in the middle-of-session group.
For the end-of-session group, the mean hemoglobin level at baseline and at month 6 was 11.8 and 11.7 g/dL, respectively, and the mean DA dose was 0.47 and 0.51 µg/kg per week, respectively. For the middle-of-session group, the mean hemoglobin level was 11.8 and 11.6 g/dL and the mean DA dose was 0.50 and 0.52 µg/kg per week.
The lack of significant differences in DA efficacy suggests a lack of clinically significant adsorption/interaction between DA and dialysis membranes and lines. “Therefore, timing of IV DA administration can be adapted to local dialysis unit routine practice without concern for impact on efficacy,” the authors concluded.
Findings were presented at the European Renal Association-European Dialysis and Transplant Association 2008 congress.