NDT Advance Access originally published online on August 25, 2006
Nephrology Dialysis Transplantation 2006 21(12):3520-3524; doi:10.1093/ndt/gfl479
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Increased injection pain with darbepoetin-
compared to epoetin-ß in paediatric dialysis patients
Division of Paediatric Nephrology, University Hospital for Paediatric and Adolescent Medicine, University of Heidelberg, Germany
Correspondence and offprint requests to: Claus Peter Schmitt, MD, Division of Paediatric Nephrology, University Hospital for Paediatric and Adolescent Medicine, Im Neuenheimer Feld 153, 69120 Heidelberg, Germany. Email: claus.peter.schmitt{at}med.uni-heidelberg.de
Background. Darbepoetin-
is applicable at longer injection intervals. Our early experience in children on peritoneal dialysis suggested increased injection pain compared to epoetin-ß, possibly due to technical differences or patient anxiety.
Methods. To verify a possible difference in the painfulness of the injected fluids per se, we performed a prospective, randomized, double-blind trial in 13 paediatric end-stage renal disease patients. They received three injections of equivalent doses of darbepoetin- or epoetin-ß in 0.6 ml saline, using neutral syringes and 27G needles, at 4 week intervals. Pain perception was recorded immediately and after 30 min on a visual analogue scale (VAS, 0 = no pain, 10 = maximal pain; complemented by 5 faces for young children).
Results. The patients perceived more intense immediate injection pain with darbepoetin- than with epoetin-ß (5.4 ± 1 vs 2.3 ± 0.6, P < 0.05). This was confirmed by the impression of the parents (5.3 ± 1 vs 2.0 ± 0.9, P < 0.05) and the nurses (4.4 ± 1 vs 2.2 ± 0.6, P < 0.05). General injection pain was inversely related to patient age (R = –0.77, P = 0.001). Six patients perceived no or a mild difference in injection pain, whereas 7 subjects reported a markedly higher pain score (
4 VAS points) with darbepoetin-. After 30 min, the injection site was largely painless with both drugs. No significant local reactions occurred with either medication (0.3 ± 0.1 vs 0.3 ± 0.1 on a 5-score scale).
Conclusions. Subcutaneous injections of darbepoetin- are more painful than those of epoetin-ß in the majority of paediatric patients. The observed difference in painfulness is related to the nature of the injected compounds and may limit the subcutaneous applicability of darbepoetin- in children.
Keywords: anaemia; darbepoetin-; epoetin-ß; paediatric dialysis; pain perception; subcutaneous injection
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