Comparison of efficacy, cost, and comfort of three sites for subcutaneous injection of erythropoietin in hemodialysis patients

Background. The efficacy, cost, and patient comfort of three commonly used sites for the subcutaneous (sle) injection of recombinant human, erythropoi etin (rHuEPO) were compared in hemodialysis (HD) subjects. Methods. Thirty-six HD patients were randomized to receive s/c rHuEPO in ei ther the arm, thigh, or abdomen in order to achieve a target hemoglobin of 11.0-13.0 g/dl. Subjects served as their own controls and were crossed-over to the next site in the above sequence after 3 months of treatment. The pr imary endpoints were the dose and cost of drug required to maintain hemoglo bin levels, as well as patient-reported adverse events assessed on a visual analogue scale. Global patient acceptance at exit was determined on a scal e of 1 to 5. Results. There was an 11% (n = 4) dropout rate due to death (n = 2), transp lantation (n = 1), and inter-hospital transfer (n = 1). Five withdrew becau se of refusal to continue with injections into the abdomen. There were no s ignificant differences in the dose or cost of rHuE-PO among the three sites . Neither were there differences in pain or discomfort during injection; in bruising, swelling, or bleeding peri-injection; or in patient anxiety. How ever, the abdomen was less convenient than the arm (p <0.05). Global patien t acceptance was higher for the arm than for the thigh or abdomen. Serum er ythropoietin concentrations, serum ferritin levels, and transferrin saturat ions were similar for the three sites. Conclusions. There is no difference in the dose requirements or cost Of mai ntaining target hemoglobin levels among the three sle rHuEPO injection site s studied Patients rate the arm as the most convenient site for s/c rHuEPO injections.