Related Experiment Video

Updated: Aug 15, 2026

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
05:23

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Published on: March 14, 2017

Darbepoetin alfa (Aranesp) in children with chronic renal failure

Denis F Geary1, Laura E Keating, Annette Vigneux

  • 1Division of Nephrology, and Department of Population Health Sciences, Hospital for Sick Children, Toronto, Ontario, Canada. Denis.Geary@sickkids.ca

Kidney International
|September 17, 2005
PubMed

Insights

Darbepoetin alfa effectively treats anemia in children with chronic renal failure (CRF) at a dose of 0.5 mcg/kg/week. Many children achieved target hemoglobin levels with less frequent injections, demonstrating safety and efficacy.

Area of Science:

  • Pediatric Nephrology
  • Hematology
  • Pharmacology

Background:

  • Limited data existed on darbepoetin alfa use in pediatric chronic renal failure (CRF).
  • Previous reports included only 7 children with CRF.
  • The study aimed to expand on this by evaluating efficacy, safety, and dosing in a larger pediatric cohort.

Purpose of the Study:

  • To assess the efficacy and safety of darbepoetin alfa in children with chronic renal insufficiency (CRI).
  • To determine an appropriate therapeutic dose for pediatric patients with CRI.
  • To evaluate hemoglobin response in children undergoing dialysis (peritoneal dialysis or hemodialysis).

Main Methods:

  • A prospective, open-label study enrolled 26 children with CRI (GFR <30 mL/min/1.73 m²).
  • Seven ineligible children were analyzed retrospectively.
  • The starting dose was 0.45 mcg/kg/week, with a primary outcome of hemoglobin (Hb) response between 10.0-12.5 g/dL.

Main Results:

  • Thirty-three children (aged 1-17 years) were included; 10 patients dropped out, none due to the study drug.
  • Mean Hb levels were 11.8 and 11.4 g/dL at 8-12 and 20-28 weeks, respectively.
  • 97% and 91% of patients achieved Hb >10.0 g/dL in the respective intervals; 87% received injections less than weekly by 28 weeks.

Conclusions:

  • Darbepoetin alfa, at approximately 0.5 mcg/kg/week, effectively treats anemia in pediatric patients with CRF.
  • The dose can be proportionally increased for many patients.
  • Less frequent administration (less than once weekly) is feasible for a significant proportion of children.
Abstract

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy01:26

Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in critically...
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...