NDT Advance Access originally published online on October 25, 2005
Nephrology Dialysis Transplantation 2006 21(2):431-436; doi:10.1093/ndt/gfi216
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Efficacy prospective study of different frequencies of Epo administration by i.v. and s.c. routes in renal replacement therapy patients
1 Division of Nephrology, Dialysis and Transplantation, Ospedale Maggiore Policlinico, Mangiagalli, e Regina Elena, Fondazione IRCCS, Milan, and 2 Division of Nephrology and Dialysis, Ospedale S.Andrea, La Spezia and 3 Section of Medical Statistics and Biometry, University of Brescia, Italy
Correspondence and offprint requests to: Professor Piergiorgio Messa, MD, Nephrology, Dialysis and Renal Transplant, Padiglione Croff, Ospedale Maggiore-IRCCS, Via Commenda 15, 20122 Milan, Italy. Email: pmessa{at}policlinico.mi.it
Background. The problem of pure red cell aplasia (PRCA) prompted nephrologists to revert to a wider intravenous (i.v.) utilization of erythropoeitin (Epo). Once weekly i.v. Epo administration has been suggested to be as effective as the twice/thrice weekly i.v. dose. The aim of the present study was to test whether once weekly i.v. Epo administration is equally as cost-effective as once weekly subcutaneous (s.c.) and 2–3 times weekly i.v. administration.
Methods. We prospectively studied 41 patients (23 males, aged 28–82 years), on renal replacement therapy for 18–286 months, stabilized on twice or thrice weekly s.c. Epo-
(basal). The patients were treated for three consecutive 6 month periods with once weekly s.c. (OWSC), once weekly i.v. (OWIV) and twice/thrice weekly i.v. (TWIV) Epo-. The initial dose for each period was equal to the final dose of the previous one; when necessary, the dose was adjusted according to DOQY guidelines. Iron, folic acid and vitamin B12 supplementations were given throughout all the study periods. At the end of each of the four study periods, the following parameters were evaluated: haemoglobin, haematocrit, hypochromic red blood cells (RBCs), iron, serum ferritin, transferrin, folate, vitamin B12, C-reactive protein (CRP), Kt/V, parathyroid hormone (PTH) and weekly dose of Epo-.
Results. Thirty-three out of 41 enrolled patients completed the study (there were five deaths, two renal transplants and one transfer). No significant changes were observed as regards iron, serum ferritin, transferrin, folate, vitamin B12, CRP, Kt/V or PTH level. Haemoglobin levels were not different at the end of the basal (11.7±1.21), OWSC (11.8±0.86) and TWIV (12.1±1.04) periods, while significantly lower levels were observed after the OWIV period (11.0±0.97, P<0.01). Weekly Epo consumption (Epo U/week/kg body weight/g haemoglobin) was: basal 11.57±5.96; OWSC 10.22±4.53; OWIV 15.99±7.7*a; and TWIV 11.89±6.3*a (*P<0.01 vs basal; aP<0.01 vs OWSC).
Conclusions. From our results, the OWIV schedule seems to have less efficacy in the control of anaemia of chronic renal failure patients on dialysis treatment than either OWSC or TWIV schedules.
Keywords: anaemia; chronic renal failure; erythropoietin