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 r oute of administration of erythropoietin (EPO) on the dose requirement in dialysis patients after intravenous (IV) and subcutaneous (SC) the rapy. 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 haemoglobi n (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 swit ched for a further 4 months (Period 2). The study included high risk p atients. The adjustment period was completed by 38 patients, Period on e 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 ra te of Hgb increase (IV 0.7 versus SC 0.5, mmol . l(-1) . month(-1)), t ime 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 treatme nt. The blood pressure did not change significantly from the base leve l after either route of administration; start 133/80 versus 143/80 mmH g, target 127/78 versus 154/85 mmHg, and maintenance period 140/84 ver sus 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 dialys is patients.