NDT Advance Access originally published online on June 1, 2005
Nephrology Dialysis Transplantation 2005 20(9):1956-1962; doi:10.1093/ndt/gfh899
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Switching from subcutaneous to intravenous erythropoietin 
in haemodialysis patients requires a major dose increase
Renal Unit, Lister Hospital, Stevenage, Hertfordshire SG1 4AB, UK
Correspondence and offprint requests to: K. Farrington, Renal Unit, Lister Hospital, Corey's Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK. Email: ken.farrington{at}nhs.net
Background. A change in the licensing arrangements for the use of erythropoietin 
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 in 86 haemodialysis patients at monthly intervals over the 6 month period before and after a change in the route of administration of erythropoietin 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 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 by 6 months. The economic impact may be considerable.
Keywords: administration route; epoietin; erythropoietin; haemodialysis; intravenous; subcutaneous
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