PROPOSED THERAPEUTIC ALGORITHM FOR THE TREATMENT OF ANEMIA OF CHRONIC-RENAL-FAILURE IN PREDIALYSIS PATIENTS WITH LOW-DOSE ONCE WEEKLY SUBCUTANEOUS RHUEPO

Anemia of chronic renal failure (CRF) prior to initiation of dialysis is an important cause of morbidity and requires early therapeutic inte rvention. The current study was designed to investigate the efficacy a nd tolerability of a therapeutic algorithm for anemia of CRF in pre-di alysis patients which is based on low dose once-a-week subcutaneous (s .c.) administration of recombinant human erythropoietin (r-HuEPO). Thi rty-one patients participated in a prospective open-label multicenter study. At baseline, hemoglobin was 8.8+/-0.1 g/dl, transferrin saturat ion 27+/-2%, ferritin 207+/-28 ng/ml and serum creatinine 4.7+/-0.2 mg /dl. Treatment with r-HuEPO was started at a fixed s.c. dose of 4,000 units once weekly, irrespective of body weight, and titrated upwards o r downwards according to a predetermined algorithm. Hemoglobin rose to levels >10 g/dl within 8 weeks and remained stable throughout the rem aining period of the study. By week 24, most patients required less th an or equal to 4,000 units/week as maintenance dose. Transferrin satur ation and ferritin concentration tended to fall during the course of r -HuEPO treatment, despite iron supplementation. There was no change in white blood cell or platelet count. Eight patients required an increa se in antihypertensive therapy, but blood pressure remained well-contr olled. Twelve patients failed to complete the full length of the study , 7 of them because dialysis had to be initiated. The rate of decline in kidney function, however, was not altered by r-HuEPO. We conclude t hat the proposed therapeutic algorithm is practical, efficacious, safe , and cost-effective.