The study was conducted to assess safety and immunogenicity of recombinant human erythropoietin (rhEPO) manufactured by Daewoong Pharmaceutical Co., Ltd was similar to biological products approved by the drug safety regulatory authority.

This study consisted of a screening period (4 weeks) and treatment period (52 weeks). Evaluation for immunogenicity effect using ADA (Anti Drug Antibody) detection will be done at weeks 0, 24, and 52 and blood sampling for Routine Hematological tests as supporting data will be conducted every month following hospital regulation. For each subject, the end of the study is the last day of the Blood sample will be drawn In the case of a subject that has left the study (withdrawn), the exit date will be the end of the study. The safety evaluation was conducted based on the incidence of the adverse events local and systemic reactions.

Inclusion Criteria:

• Patients who have anemia associated with Chronic Kidney Disease (CKD) under hemodialysis treatment.
• Male or female patients aged ≥18 years.
• Patients with mean Hb concentration when screening is around ≤10 g/dL.
• Patients on stable, adequate dialysis for at least three months (defined as no clinically relevant changes of hemodialysis regimen and/or 23/42 ©EMEA 2007 dialyzer).
• Has ever been using Epodion treatment in the at least last 1 month.
• Haemodialysis patients who likely to remain on Epodion treatment for 52 weeks.
• Informed consent given in a written form after being provided with detailed information about the nature, risks, and scope of the clinical trial as well as the expected desirable and adverse effects of the drug.

Exclusion Criteria:

• History of Pure Red Cell Aplasia (PRCA) or anti-epoetin antibodies.
• Contraindications for ESA therapy.
• Systemic immunosuppressive medication or any other drugs known to adversely affect the hemoglobin level.
• History of uncontrolled hypertension (defined as systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg during screening).
• Any blood transfusion within the last 2 weeks prior to screening period.
• Major surgery within 3 months prior to screening period.
• Myelodysplastic syndrome.
• History bleeding disorders (e.g. Hemophilia, Von Willebrand, and any conditions that result when the blood cannot clot properly).
• Known bone marrow fibrosis (osteitis fibrosa cystica).
• Known epilepsy.
• Liver cirrhosis with clinical evidence of complications (portal hypertension, splenomegaly, ascites).
• Systemic lupus erythematosus.
• Previously diagnosed with HIV or acute hepatitis infection.
• History of malignancy of any organ system within the last 5 year.
• Pregnancy or lactation period in female patients.
• Heavy smoker (who smoke over 20 cigarettes daily in average).

The study is conducted on Patients who have anemia associated with Chronic Kidney Disease (CKD) under hemodialysis treatment and Have been using Epodion treatment for at least the last 1 month in several hospitals in Jakarta.