ONE-YEAR EXPERIENCE OF VERY-LOW DOSES OF SUBCUTANEOUS ERYTHROPOIETIN IN CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS AND ITS EFFECT ON HEMOSTASIS

Recombinant human erythropoietin (rHuEpo) is now well established in t he management of the anaemia associated with chronic renal failure. Th e aim of this study was to assess the efficacy and safety of low doses of subcutaneous (s.c.) erythropoietin in continuous ambulatory perito neal dialysis (CAPD) patients and particularly its effects on haemosta sis. Seven CAPD patients were given s.c. erythropoietin for more than 1 year. Their mean age was 36.2 +/- 9.2 years and their mean pretreatm ent haemoglobin (Hb) was 7.05 +/- 0.53 g/dl. All patients were started on 20 U/kg, 3 times/week, to be doubled every 4 weeks if no response was obtained. Five patients had a good response and attained the targe t Hb of 10-12 g/dl and were maintained on low doses of rHuEpo (20 U/kg s.c., twice a week). A marked improvement in haemostatic function was noted when comparing the pre- with the post-treatment measurements. T here was a significant reduction in the bleeding time, significant inc reases in fibrinogen and factor VIII clotting activity but not in von Willebrand factor antigen or ristocetin cofactor. There was also simul taneous enhancement of the platelet aggregation responses to adrenalin , collagen, arachidonic acid and ADP. In conclusion, long-term treatme nt with small doses of s.c. rHuEpo is safe, convenient and effective i n correcting anaemia in patients on CAPD, rHuEpo caused significant im provement of bleeding time which can be explained partly through the c orrection of anaemia and in part by the improvement in haemostatic fun ction.