Darbepoetin for the anaemia of chronic kidney disease

Darbepoetin alfa may be effective for the anaemia and may reduce need for blood transfusions in adults with chronic kidney disease stage 3 to 5, but has little or no effect on mortality or quality of life.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, incomplete outcome data, no blinding).

Summary

A Cochrane review included 21 studies invovling a total of 8 328 participants. In a single large study, darbepoetin alfa reduced the need for blood transfusion (RR 0.60, 95% CI 0.53 to 0.69; n=4038) and iron therapy compared with placebo in adults with CKD stage 3 to 5, but had little or no effect on survival (RR 1.05, 95% CI 0.93 to 1.19; n=4038), increased risks of hypertension, and had uncertain effects on quality of life. Data comparing darbepoetin alfa with epoetin alfa or beta or methoxy polyethylene glycol-epoetin beta were sparse and inconclusive. Comparisons of differing dosing schedules and routes of administration were compared in small numbers of participants and studies. Evidence for treatment effects of darbepoetin alfa were particularly limited for children with CKD, adults with CKD stage 5D, and recipients of a kidney transplant.

Clinical comments

Date of latest search:13 January 2014

Ədəbiyyat

1. Palmer SC, Saglimbene V, Craig JC et al. Darbepoetin for the anaemia of chronic kidney disease. Cochrane Database Syst Rev 2014;(3):CD009297.