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.