Subcutaneous erythropoietin results in lower dose and equivalent hematocrit levels among adult hemodialysis patients: Results from the 1998 end-stagerenal disease core indicators project

The National Kidney Foundation's Dialysis Outcome Quality Initiative (NKF-D OQI) guidelines recommend that epoetin alfa should be administered by the s ubcutaneous route in hemodialysis patients. We determined whether hematocri t levels in hemodialysis patients differed by route of epoetin alfa adminis tration after controlling for demographic factors and iron status. Data wer e available for 7,092 of the 7,658 patients randomly chosen for inclusion i n the 1997 Health Care Financing Administration Core Indicators sample. Epo etin alfa was administered to 96% of the study cohort and was administered subcutaneously in 10% of patients. After controlling for hematocrit, patien t characteristics, adequacy of dialysis, iron status, serum albumin, postdi alysis weight, and duration of dialysis, the epoetin alfa dose by the intra venous route was 193.6 units/kg/wk (95% confidence interval, 189.5 to 197.8 units/kg/wk) compared with 167.4 units/kg/wk (95% confidence interval, 153 .9 to 180.8 units/kg/wk) for the subcutaneous route (P < 0.001). The mean h ematocrit for the subcutaneous route was 32.7% +/- 3.4% and for the intrave nous route was 33.0% +/- 3.2% (P < 0.05). Factors independently associated with increased hematocrit included male gander, white race, older patient a ge, greater number of years on dialysis, higher serum albumin concentration , higher urea reduction ratio, and percent transferrin saturation (all P < 0.001). After controlling for patient factors and weekly epoetin alfa doss, there was no association between route of epoetin alfa administration and hematocrit level (P = 0.144). Patients receiving epoetin alfa by the subcut aneous route had comparable hematocrit values using a lower epoetin alfa do se than patients receiving epoetin alfa intravenously. These data support t he NKF-DOQI recommendation that epoetin alfa be administered subcutaneously in long-term hemodialysis patients. (C) 2001 by the National Kidney Founda tion, Inc.