Toto R, Petersen J, Berns JS, et al. - Among 756 adults with stage-3 to -5 CKD and anemia, this phase-3, randomized trial was conducted to determine if using a low fixed erythropoiesis-stimulating agent (ESA) dose vs dosing based on a hemoglobin-based, titration-dose algorithm in these patients might decrease risks related to high ESA doses and reduce the cumulative exposure while attenuating the requirement for red blood cell transfusions. Experts assessed red blood cell transfusion incidence for patients who were randomly assigned to receive darbepoetin administered as a fixed dose (0.45 µg/kg every 4 weeks) vs given as per a hemoglobin-based, titration-dose algorithm, for up to 2 years. Significantly higher median hemoglobin was detected in the titration-dose group vs the fixed-dose group. The fixed-dose group, vs the titration-dose group, had a significantly lower median cumulative dose of darbepoetin. Experts found that the incidence of red blood cell transfusion did not differ between a titration-dose strategy vs a fixed-dose strategy for darbepoetin. This indicates that a low fixed dose of darbepoetin may be employed as a substitute for a dose-titration approach to reduce transfusions, with less cumulative dosing.