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ALTERNATE is an international observational study evaluating biweekly darbepoetin alfa (DA) in adult dialysis patients in clinical practice. Austrian ALTERNATE results are presented here (n = 505). The follow-up study ALTERNATE follow-up (AFU) followed Austrian ALTERNATE patients for an additional 12 months (n = 135). Data were collected 6 months before and 12 months after conversion to biweekly dosing and during 12 months of follow-up. The primary measures were hemoglobin concentration 12 months after conversion and at the end of AFU, respectively. Mean (95 % CI) hemoglobin (g/dL) was 11.87 (11.75–11.99) at conversion, 11.71 (11.58–11.83) at month 12, and 11.66 (11.45–11.86) at end of AFU. Geometric mean (95 % CI) weekly dose (μg/wk) was 32.97 (30.80–35.30) at conversion, 29.90 (26.71–33.46) 12 months after conversion, and 24.38 (18.40–30.35) at end of AFU. The studies show that hemoglobin and dose could be effectively maintained over an extended period of time after conversion from higher frequency erythropoiesis-stimulating agents to biweekly DA.