LOW SUBCUTANEOUS DOSES OF ERYTHROPOIETIN IN PATIENTS WITH ESRD ON HEMODIALYSIS

Eighteen patients with chronic renal failure and related anemia, all o f them on regular hemodialysis, with good quality treatment judged by (KT/V > 1.2, and urea reductions ratio greater than or equal to 0.38), with mild hyperparathyroidism (PTHi 138 +/- 97 pg/mL), with no folic acid or vitamin B12 deficiency, and with ferritin levels of 160 mg/mL, received subcutaneous (sc) EPO 35 U/kg body weight, twice per week. T heir initial hemoglobin (Hb) of 6.7 +/- 0.7 g/dL increased to 9.8 +/- 1.4 at the end of the first part of this procotol (12 weeks) (p < 0.00 1); the blood levels of EPO increased from 8.1 +/- 5 U/mL to 34 +/- 9 (p < 0.001), which were enough to stimulate red cell progenitors. In t he 2nd study period, also of 12 weeks, 10 patients from the first stud y were given EPO in a dose of 25 U/kg BW subcutaneously twice a week t o maintain a level of Hb (10.5 g/dL) (p > 0.01). Their EPO levels were twice as high as the basal levels (p < 0.001) 18 hrs after the admini stered dose. There were no changes other blood parameters, electrolyte s or blood chemistry. An increase in the reticulocyte count was observ ed, with low sideremia (serum ferritin and percentage saturation of tr ansferrin). There were a few complications; three patients previously hypertensive increased their blood pressure, but this was easily contr olled. We conclude that the response to EPO is dependent on its route of administration, plasma level serum and half life, iron level, dialy sis adequacy, and comorbid diseases.