We suggest that the frequency of administration should be determined by the CKD grade, preferences of treated population, treatment setting and class of ESA. Less frequent administration using long-acting ESAs may be the treatment of choice in people with CKD not on haemodialysis. (2B)
Rationale
The frequency of ESA administration should be determined by the CKD treatment setting and the class of ESA. Maximum efficacy is achieved by using the dosing intervals that are ESA class specific. In people receiving HD prescribed SC short-acting ESA therapy, ESA efficacy is maximal when the drug is given thrice weekly. Short-acting ESA efficacy decreases and dose requirement increases, when the dosing frequency is extended from thrice-weekly to once-weekly administration (1). Increasing the time interval between dosages of long-acting ESAs could also result in an increase in dose requirements (2). Doses and dosing intervals should be tailored to each individual person’s response to therapy. Use of algorithms may assist in optimising therapy (3).
References
- Tolman C, Richardson D, Bartlett C et al. Structured conversion from thrice weekly to weekly erythropoietic regimens using a computerized decision-support system: A randomized clinical study. J Am Soc Nephrol 2005; 16:1463-1470.
- Jadoul M, Vanrenterghem Y, Foret M et al. Darbepoetin α administered once monthly maintains haemoglobin levels in stable dialysis patients. Nephrol Dial Transplant 2004;19:898-903.
- Lines SW, Lindley EJ, Tattersall JE and Wright MJ. A predictive algorithm for the management of anaemia in haemodialysis patients based on ESA pharmacodynamics: better results for less work. Nephrol Dial Transplant 2012; 27: 2425–2429.