Administration of the same dose of epoetin-beta intravenously and subcutaneously to patients with renal anaemia

Abstract

Objective. Subcutaneous (s.c.) administration of erythropoietin (EPO) is recommended over the intravenous (i.v.) route to reduce doses and costs. Optimal iron treatment is important for the optimal EPO effect. This study investigated whether the haemoglobin (Hb) level of a single patient could be preserved with the same dose of EPO given i.v. as given s.c. Material and methods. One-hundred and forty-five haemodialysis patients with the same weekly EPO dose s.c. for 3 months and a stable Hb (maximum fluctuation of 1 mmol/l) were randomized in a crossover study to group A (4 months i.v. then 4 months s.c. EPO) or group B (4 months s.c. then 4 months i.v. EPO, with unchanged EPO dose). Ferritin had to be 300–800 μg/l or transferrin saturation ≥20%. Patients with a fall in Hb >1 mmol/l were withdrawn. Results. Ferritin and transferrin saturation remained within the target range, and mean Hb in the range of 1 mmol/l. Mean EPO doses were unchanged in both groups, and no difference was found between the dropouts due to Hb fall >1 mmol/l in the i.v. and s.c. groups during the first period of the trial. Conclusion. In iron-replete haemodialysis patients the same EPO dose given intravenously is just as effective as given subcutaneously.

Key Words::

• erythropoietin administration
• haemodialysis
• intravenous
• iron-replete
• subcutaneous

Acknowledgements

We gratefully acknowledge the participating dialysis units for their contribution and help. Dialysis units (principal investigator) were as follows: Department of Medicine, Lillebælt Hospital, Fredericia, Denmark (Gudrun K. Steffensen), Department of Medicine, Roskilde Hospital, Roskilde, Denmark (Ove Østergaard), Department of Nephrology, University Hospital of Odense, Denmark (Per B. Jensen), Department of Nephrology, Herlev Hospital, Herlev, Denmark (Folmer Lynggaard), Department of Medicine, Sønderborg Hospital, Sønderborg, Denmark (Stig Lykkegaard), Department of Medicine, Holbæk Hospital, Holbæk, Denmark (Jørgen Esmann). We thank Roche, Denmark, for cooperation and financial support.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.