DAILY SUBCUTANEOUS ADMINISTRATION OF RECOMBINANT-HUMAN-ERYTHROPOIETIN(RHEPO) IN PERITONEAL-DIALYSIS PATIENTS - A EUROPEAN DOSE-RESPONSE STUDY

In a prospective randomized open multicenter study, 107 anemic (Hct < = 28%) peritoneal dialysis (PD) patients were treated with s.c. rhEPO daily. The mean observation period was 299 days (range 14-479 days). P atients were randomly assigned to 3 groups with different initial dose s: 5 U/kg (G5), 10 U/kg (G10), 20 U/kg (G20). Initial doses were maint ained for at least 8 weeks unless the target Hct (30-35%) was achieved earlier. The weekly increase of Hct was significantly (p < 0.05) dose -dependent: 0.19% in G5, 0.5% in G10 and 0.94% in G20. In case of insu fficient response (<0.5% per week), the dose was doubled every 4 weeks . Final doses on achieving the target Hct ranged from 5 to 40 U/kg (me dian 20 U/kg). The dose was then reduced to 50% and adjusted individua lly. The median maintenance dose was 9.9 U/kg/day. No tendency towards higher blood pressure or intensification of antihypertensive treatmen t was observed. When rhEPO is administered daily, 10 U/kg/day (70 U/kg weekly) is the recommended starting dose. The need for higher doses u sed in unsatisfactory response, should lead to further examination to rule out iron deficiency and other reasons for non-response. The media n maintenance dose reported here is the lowest published in the litera ture for PD patients and seems to be linked to the daily injections.