INCREASE OF THE BIOAVAILABILITY OF INTRAPERITONEAL ERYTHROPOIETIN IN CHILDREN ON PERITONEAL-DIALYSIS BY ADMINISTRATION IN SMALL DIALYSIS BAGS

Objective: To establish the effectivity of administration of erythropo ietin intraperitoneally in a small amount of fluid in children with re nal anemia on continuous ambulatory peritoneal dialysis (CAPD). Design : Prospective study in which children with renal anemia on CAPD were t reated with erythropoietin intraperitoneally, administered in a specia lly designed bag containing 50 mL NaCl 0.9%. Setting: University hospi tal. Patients: The patient population consisted of 9 children treated with CAPD and 1 treated with nightly intermittent peritoneal dialysis. The median age was 7.8 years (range 4.1 - 15.2). Four of these childr en had not been treated with erythropoietin before (group A), and 6 ha d been treated with erythropoietin administered intraperitoneally in 2 50 mt of dialysis fluid (group B). Interventions: Patients in group A started on a dose of approximately 300 units/kg per week (group A). Pa tients in group B received their previous dose. Dosage was adjusted to achieve a target hemoglobin level of 6.5 - 7.0 mmol/L (104 - 112 g/L) . Serum ferritin levels and transferrin saturation were monitored and iron supplementation was prescribed in the case of iron deficiency. Ma in outcome measures: Weekly erythropoietin dose in relation to hemoglo bin level. Results: In group A, median hemoglobin level rose from 5.3 mmol/L (85 g/L) to 6.6 mmol/L (106 g/L) after 6 months of therapy, whe reas the median erythropoietin dose decreased from 266 to 234 U/kg/wee k. In group B, hemoglobin levels remained stable and median erythropoi etin dose decreased from 262 to 194 U/kg/week. One patient in this gro up, for unknown reasons, never responded to erythropoietin treatment. He was excluded from further analysis. In the remaining 5 patients the median cumulative erythropoietin dose was 3250 U/kg in the 3-month pe riod prior to the start of the study and 2713 in the 3-month period st arting 6 months after the beginning of the study. This difference of 1 7% was statistically significant using a Wilcoxon test (p < 0.05). Con clusion: Intraperitoneal administration of erythropoietin in a small a mount of dialysis fluid leads to a decrease in the required dose.