SUBCUTANEOUS COMPARED WITH INTRAVENOUS EPOETIN IN PATIENTS RECEIVING HEMODIALYSIS

Background Several studies have suggested that if recombinant human er ythropoietin (epoetin) is administered subcutaneously rather than intr avenously, a lower dose may be sufficient to maintain the hematocrit a t a given level. Methods In a randomized, unblinded trial conducted at 24 hemodialysis units at Veterans Affairs medical centers, we assigne d 208 patients who were receiving long-term hemodialysis and epoetin t herapy to treatment with either subcutaneous or intravenous epoetin. T he dose was initially reduced until the hematocrit was below 30 percen t and then was gradually increased to a level that would maintain the hematocrit in the range of 30 to 33 percent for 26 weeks. We compared the average doses in the 26-week maintenance phase and the discomfort associated with the two routes of administration. Results For the 107 patients treated by the subcutaneous route, the average weekly dose of epoetin during the maintenance phase was 32 percent less than that fo r the 101 patients treated by the intravenous route (mean [+/- SD], 95 .1 +/- 75.0 vs. 140.3 +/- 88.5 U per kilogram of body weight per week; P<0.001). Only one patient in the subcutaneous-therapy group withdrew from the study because of pain at the injection site, and 86 percent rated the pain associated with subcutaneous administration as ranging from absent to mild. Conclusions In patients receiving hemodialysis, s ubcutaneous administration of epoetin can maintain the hematocrit in a desired target range, with an average weekly dose of epoetin that is lower than with intravenous administration. (N Engl J Med 1998; 339:57 8-83.) (C) 1998, Massachusetts Medical Society.