Journal Article

Switching from subcutaneous to intravenous erythropoietin α in haemodialysis patients requires a major dose increase

Jack W. Galliford, Rao Malasana and Ken Farrington

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 20, issue 9, pages 1956-1962
Published in print September 2005 | ISSN: 0931-0509
Published online May 2005 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfh899
Switching from subcutaneous to intravenous erythropoietin α in haemodialysis patients requires a major dose increase

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Background. A change in the licensing arrangements for the use of erythropoietin α in haemodialysis patients has required a switch in the route of administration from subcutaneous (SC) to intravenous (IV). Previous work suggested that the IV route was less efficacious but studies since the enforced switch have not confirmed this.

Methods. We studied haemoglobin levels and the mean weekly dose of erythropoietin α in 86 haemodialysis patients at monthly intervals over the 6 month period before and after a change in the route of administration of erythropoietin α from SC to IV. Changes in other parameters known to be associated with erythropoietin response were also monitored.

Results. Mean haemoglobin level fell following the switch from 11.9 g/dl±1.4 at baseline to 11.3 g/dl±1.4 at 1 month (P = 0.001) and to a trough of 11.0 g/dl±1.3 at 2 months (P<0.001) before partial recovery to 11.4 g/dl±1.2 (P = 0.007) at 6 months. Mean weekly dose of erythropoietin after 2 months was significantly higher than baseline (8791 IU±5314 vs 8035 IU±4893). The dose continued to increase and by 6 months was 10605 IU (P<0.001), 32% higher than baseline. There was a small reduction in residual renal function, which was an independent predictor of change in dose requirement. There was a small increase in parathyroid hormone levels, but no change in serum ferritin, dosing frequency, total Kt/V, serum albumin, normalised protein catabolic rate, C-reactive protein, hospitalization rate and dialyser reuse rate.

Conclusions. Switching from SC to IV erythropoietin α caused a significant fall in haemoglobin levels in the first 2 months. This was partially reversed by 6 months at the expense of a 32% dose increase in the dose of erythropoietin α by 6 months. The economic impact may be considerable.

Keywords: administration route; epoietin; erythropoietin; haemodialysis; intravenous; subcutaneous

Journal Article.  3727 words.  Illustrated.

Subjects: Nephrology

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