High-dose darbepoetin therapy in a diabetic kidney disease patient with myelodysplastic syndrome

Abstract

We report a diabetic kidney disease patient with myelodysplastic syndrome (MDS) who was treated with high-dose darbepoetin-alfa and whose anemia improved, making it possible to decrease the use of red blood cell transfusion. He was diagnosed with diabetic kidney disease and MDS at the age of 74 years. He continued to have severe anemia despite continuous treatment with an erythropoiesis-stimulating agent (ESA) and transfusions as an outpatient. He was admitted to our hospital for severe anemia and over-hydration at 76 years of age. On admission, his hemoglobin was 6.8 g/dL and he experienced frequent angina attacks. After initiating dialysis, the dosage of darbepoetin-alfa was increased gradually to 180 μg administered intravenously weekly. As a result, his hemoglobin concentration was sustained at 8.0～9.0 g/dL, the frequency of transfusion could be reduced, and the angina attacks disappeared. However, his serum ferritin level increased and we attempted treatment with an oral iron-chelating agent, but severe nausea developed. High-dose ESA might be effective for MDS patients with CKD.