Comparison of dose requirement, serum erythropoietin and blood pressure following intravenous and subcutaneous erythropoietin treatment of dialysis patients - IV and SC erythropoietin

Objective: The purpose of the study was to investigate the effect of route of administration of erythropoietin (EPO) on the dose requirement in dialysis patients after intravenous (IV) and subcutaneous (SC) therapy. Methods: The study was performed as a single centre, prospective, open, combined parallel and cross-over study of 50 dialysis patients, consecutively randomised to IV., SC treatment with EPO. The initial dose was 40 U . kg(-1) 3-times weekly, adjusted to increase haemoglobin (Hgb) from a median 5.3 mmol . l(-1) to a target of haemoglobin 6.5-7.5 mmol . l(-1). After reaching the target level, the haemoglobin was maintained for 4 months (Period I). Then IV and SC treatment was switched for a further 4 months (Period 2). The study included high risk patients. The adjustment period was completed by 38 patients, Period one by 32 patients (IV/SC = 15/17; male/female = 19/13; age = 54 (24-71) y), and Period two by 22 patients. Results: No significant difference was found between the two groups in the reticulocyte response, the rate of Hgb increase (IV 0.7 versus SC 0.5, mmol . l(-1) . month(-1)), time to reach target level (IV 43 versus SC 60 days), or total EPO dose per increase in haemoglobin to target level (TV 663 versus SC 946 (U . kg(-1)) per (mmol Hgb . l(-1)). The overall median maintenance dose during the last month of the two four month periods was 105 (range IV 51-336) U . kg(-1) . w(-1) and SC 104 (range 21-321) U . kg(-1) . w(-1). Trough serum EPO levels were significantly higher during SC treatment. The blood pressure did not change significantly from the base level after either route of administration; start 133/80 versus 143/80 mmHg, target 127/78 versus 154/85 mmHg, and maintenance period 140/84 versus 142/85 mmHg. Thus, three-times weekly IV or SC EPO did not differ significantly in efficacy or in the effect on blood pressure in dialysis patients.