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NEPHROLOGY

Erythropoietin Dose Requirements When Converting from Subcutaneous to Intravenous Administration Among Patients on Hemodialysis

Associate Professor, University of Western Ontario, London Health Sciences Centre—Victoria Hospital, London, Ontario, Canada

Norm Muirhead, MBChB MD

Professor of Medicine, University of Western Ontario and London Health Sciences Centre

Lori D Wazny, PharmD

Pharmaceutical Care Coordinator, Manitoba Renal Program, Department of Pharmaceutical Services, Health Sciences Centre, Winnipeg, Manitoba

Kerri L Gallo, RN

Research Coordinator, London Health Sciences Centre

A Paul Heidenheim, MA

Division of Nephrology, London Health Sciences Centre

Andrew A House, HBSc MD ABIM MSc

Associate Professor of Medicine, University of Western Ontario and London Health Sciences Centre

Reprints: Dr. Moist, University of Western Ontario, London Health Sciences Centre—Victoria Hospital, 800 Commissioners Rd. E., London, ON N6A 4G5, Canada, fax 519/685-8449, louise.moist{at}lhsc.on.ca

BACKGROUND: The optimal route for administration of exogenous erythropoietin remains controversial, particularly after the increased incidence in pure red cell aplasia. In Canada, the majority of hemodialysis units have converted to the intravenous route for administration of erythropoietin to potentially decrease the risk of pure red cell aplasia.

OBJECTIVE: To compare the difference in the weight-adjusted, weekly erythropoietin dose (units/kg/wk) administered by the subcutaneous compared with the intravenous route in a chronic hemodialysis population followed for 12 months.

METHODS: This prospective cohort study recruited patients receiving subcutaneous erythropoietin for at least 3 months while undergoing dialysis in a tertiary care hemodialysis program. Participants were switched to intravenous erythropoietin, and the average weekly dose was recorded at 1, 2, 3, 6, and 12 months. Anemia management and hemoglobin, iron, and delivered dialysis dose targets remained constant throughout the study.

RESULTS: The erythropoietin dose increased by 24.5 units/kg/wk (95% CI 12.7 to 36.3; p < 0.001), representing a 20.2% increase (95% CI 10.5% to 29.9%; p < 0.001) 12 months after conversion from the subcutaneous to intravenous route of administration. Both patients with and without residual renal function at baseline required a significant increase in the intravenous dose.

CONCLUSIONS: A 20.2% increase in erythropoietin dose was required to maintain hemoglobin targets between 11 and 12 g/dL after conversion from a subcutaneous to intravenous formulation. Healthcare funding agencies need to reexamine the cost benefit of using intravenous erythropoietin in the hemodialysis population with a low incidence of pure red cell aplasia.

Key Words: dosage, erythropoietin, hemodialysis

Published Online, January 31, 2006. www.theannals.com, DOI 10.1345/aph.1G425