BACKGROUND: In non-dialysis patients (ND-CKD), C.E.R.A. has been extensively 
investigated in ESA-naïve subjects but no data are available on its efficacy 
after switch from other ESA.
METHODS: In this prospective, multicenter, open-label study lasting 24 weeks, 
ND-CKD patients (n = 157) receiving ESA were converted to C.E.R.A. at doses 
lower than recommended. Primary outcome was the prevalence of Hb target (11-12.5 
g/dl).
RESULTS: Age was 73 ± 13 years and GFR was 26.2 ± 9.4 ml/min/1.73 m(2); male 
gender, diabetes and prior cardiovascular disease were 49, 33 and 19%, 
respectively. Doses of darbepoetin (25 ± 16 µg/week, n = 124) and epoetin (5,702 
± 3,190 IU/week, n = 33) were switched to low dose C.E.R.A. (87 ± 17 µg/month). 
During the study, prevalence of Hb target increased from 60% to 68% at week-24, 
while that of Hb < 11 g/dl declined from 32% to 16% (p < 0.001). Hb increased 
from 11.3 ± 0.8 at baseline to 11.7 ± 0.9 g/dl at week-24 (p = 0.01) without 
changes in C.E.R.A. dose. Significant predictors of Hb increase were low BMI, 
low Hb and longer dosing intervals before switch. These factors also predicted 
the risk of Hb overshooting (Hb > 12.5 g/dl) occurring in 57 patients.
CONCLUSIONS: In ND-CKD, conversion from other ESAs to C.E.R.A. is associated 
with a better anemia control induced by a greater Hb increase in patients 
previously treated with ESAs at extended dosing interval. This parameter should 
be considered when switching to long-acting ESA for its potential impact on the 
risk of overshooting.