NDT Advance Access originally published online on August 5, 2006
Nephrology Dialysis Transplantation 2006 21(11):3202-3206; doi:10.1093/ndt/gfl386
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Effectiveness of weekly darbepoetin alfa in the treatment of anaemia of HIV-infected haemodialysis patients*
1Department of Nephrology, Hospital de Santa Cruz, Carnaxide and 2Dialysis Unit, Eurodial, Leiria, Portugal
Correspondence and offprint requests to: Dr Fernando Carrera, Eurodial, Rua da Carrasqueira 19, Parceiros, 2400 – 441 Leiria, Portugal. Email: fcarrera{at}mail.telepac.pt
Background. Anaemia is aggravated by the coexistence of chronic kidney disease (CKD) in patients infected with human immunodeficiency virus (HIV). Darbepoetin alfa effectively alleviates CKD-associated anaemia with less frequent dosing than recombinant human erythropoietin (EPO). The current study aimed to determine the efficacy, safety and cost-effectiveness of darbepoetin alfa compared with erythropoietin alfa (EPO-alfa) for treatment of anaemia in HIV-infected subjects receiving haemodialysis.
Methods. An open label, single arm, prospective study of 12 haemodialysis subjects with HIV infection was conducted for a duration of 6 months after switching from intravenous (i.v.) EPO-alfa two/three times weekly to i.v. darbepoetin alfa once weekly. The primary end point was the proportion of patients maintaining haemoglobin (Hb) levels 
11 g/dl while a weekly dose of darbepoetin alfa was a secondary end point.
Results. Darbepoetin alfa, as effectively as EPO-alfa maintained the proportion of the subjects having Hb levels 11 g/dl at an average weekly dose of 40.60 µg compared with an equivalent dose of 51.84 µg for EPO-alfa. Antiretroviral therapy and HIV infection stage remained the same for each specific patient throughout the study period, including the last 6 months of EPO-alfa therapy. No difference in the incidence of adverse effects was observed after switching from EPO-alfa to darbepoietin alfa.
Conclusions. Lower doses of darbepoetin alfa at extended dosing interval is as safe and effective as EPO-alfa for treating anaemia, suggesting that darbepoetin alfa is a more cost-effective therapeutic alternative to EPO-alfa in the management of anaemia associated with HIV infection in subjects receiving haemodialysis.
Keywords: anaemia; chronic kidney disease; darbepoetin alfa; erythropoietin alfa; human erythropoietin; human immunodeficiency virus
* The results presented in this manuscript have been published previously in outline, as a poster, at the ERA-EDTA XLI Congress held in Lisbon from May 15 to 18, 2004.