CERA conversion to darbepoetin alfa in 154 hemodialysis patients.

PURPOSE: Anemia is a common complication in dialysis patients, usually treated with erythropoietin (EPO). Among available EPOs and analogs, continuous erythropoietin receptor activator (CERA) and darbepoetin alfa (DA) are the only two agents with a long duration of action, although they have almost never been formally compared in terms of efficacy. We took advantage of an accidental disruption in CERA supply to study the effect of its replacement with DA in the same patients. METHODS: The clinical and biological characteristics of 154 hemodialysis patients were retrospectively reviewed during the last 3 months on CERA compared to the first 4 months after replacement by DA, both ASE being administered by IV route. The comparison included EPO doses, hemoglobin levels, factors interfering with anemia (iron status assessment, iron doses, inflammation, quality of treatment) and was performed under the Bayesian paradigm. RESULTS: We found no significant differences between the two EPOs in terms of doses or hemoglobin concentrations. Factors that could potentially influence hemoglobin concentrations also did not differ under CERA or DA. The stability of hemoglobin was identical with both EPOs. We provide a conversion factor which allows comparison of cost according to local prices. CONCLUSIONS: We conclude that, in this observational "real life" study, the two EPOs are to be considered as equivalent.

Cryoglobulinemia revealed by a Purtscher-like retinopathy.

PURPOSE: To demonstrate the importance of collaboration between ophthalmologists and internists. DESIGN: Cryoglobulinemia is a systemic vascularite. Ophthalmologic complications are rare and not well known. Purtscher-like retinopathy may occur in this context. CASE REPORT: We report the case of a patient who presented a severe visual loss in the course of a hepatitis C. The ophthalmic examination shows a both ischemic and hemorrhagic bilateral retinopathy called Purtscher-like retinopathy. Cryoglobulinemia complicating a hepatitis C was discovered in our patient. CONCLUSIONS: This case illustrates a cryoglobulinemia complicating by a Purtscher-like retinopathy. The diagnosis has been possible thanks to collaboration between ophthalmologists and internists. We propose a few hypotheses to explain retinopathy pathogeny.