Intraperitoneal erythropoietin in children on peritoneal dialysis: A studyof pharmacokinetics and efficacy

The pharmacokinetics and efficacy of intraperitoneal (IP) recombinant human erythropoietin (rHuEPO) were investigated in children undergoing chronic p eritoneal dialysis. Eight children were administered a single dose of 100 U /kg of rHuEPO IP with 50 mL of dialysate into a dry peritoneal cavity after nighttime peritoneal dialysis, Serum erythropoietin (EPO) levels were meas ured at 0, 8, 12, and 24 hours. A mean peak EPO level of 187 mU/mL was obta ined at 12 hours. The area under the curve was 5,818 mU/h/mL, and relative bioavailabilty was similar to that found using subcutaneous (SC) dosing. Ni ne children completed 11 to 12 weeks of IP rHuEPO therapy. The patients mai ntained a normal hematocrit (34% +/- 2.3%) with a mean final IP rHuEPO dosa ge that was not significantly greater than the mean previous SC dosage (IP, 290 +/- 194 U/kg/wk; SC, 279 +/- 126 U/kg/wk; P = not significant). There appeared to be a trend for a slightly increased risk for peritonitis compar ed with historical controls at our center (relative risk = 3.1; 95% confide nce interval, 0.92 to 6.3). IP rHuEPO is effective in children undergoing c ontinuous cycling peritoneal dialysis without requiring increased rHuEPO do sages, but the possibility of an increased risk for peritonitis will need t o be further explored. (C) 1999 by the National Kidney Foundation, Inc.