Abstract
A 34-year-old male was started on peritoneal dialysis (PD) for end-stage renal disease due to non-IgA mesangial proliferative glomerulonephritis in March 2006. Idiopathic anemia had previously been diagnosed in 1990. Because severe anemia required frequent red blood cell transfusions, he was hospitalized for further examination in August 2006. Based on bone marrow findings, he was diagnosed as having myelodysplastic syndrome classified as refractory anemia (RA). Administration of anabolic steroids was started and we switched him from PD alone to combined therapy with PD and hemodialysis (HD) in order to achieve more adequate clearance with a higher dosage of ESA at HD sessions. However his hemoglobin concentration did not rise, so we changed the ESA from epoetin beta to darbepoetin alfa, the dosage of which was gradually increased to 180μg administered intravenously weekly. This resulted in reducing the frequency of transfusions and improving anemia. High-dose darbepoetin treatment may be effective for management of low- risk MDS. We expect that ESA will be widely available not only for chronic kidney disease (CKD) patients but also for MDS patients in the future.
