Darbepoetin alfa is more effective than epoetin-β in suppressing hepcidin and improving iron utilization in maintenance hemodialysis patients.

OBJECTIVE

This study aimed to compare the dynamics of serum hepcidin and iron metabolism markers in maintenance hemodialysis patients treated with reconstituted human Erythropoietin-β (EPO-β) and darbepoetin alfa (DA).

METHODS

This retrospective observational study included 105 patients on maintenance hemodialysis. Of these, 64 were in the EPO-β group (administered 2-3 times weekly) and 41 in the DA group (administered once every two weeks). Serum hepcidin, ferritin, transferrin saturation (TSAT), high-sensitivity C-reactive protein (hs-CRP), serum iron and hemoglobin (Hb) were measured at baseline, at week 8 and at week 12. A correlation analysis was performed. For the repeated measures analysis of variance comparing multiple time points (baseline, week 8 and week 12) between the two groups, Bonferroni post-hoc tests were used to perform pairwise comparisons.

RESULTS

Serum hepcidin decreased continuously in both groups during the 12-week treatment duration. At week 12, the DA group exhibited significantly lower hepcidin levels compared with EPO-β group. The Δhepcidin from baseline to week 12 was significantly greater in the DA group. The DA group also showed significant improvements in iron metabolism markers, with a greater decrease in TSAT, and a greater increase in serum iron compared to the EPO-β group. The erythropoiesis-stimulating agents resistance index (ERI) was significantly lower in the DA group than in the EPO-β group. LnΔhepcidin showed a positive correlation with LnΔFerritin, LnΔTSAT, LnΔSerum iron, and LnΔHb. The rates of adverse events were comparable between the two groups.

CONCLUSION

Compared to EPO-β, DA more effectively suppresses hepcidin, improves iron metabolism markers, and achieves higher erythropoietic efficiency, with comparable Hb response rates and safety profiles between the two groups.