Iron-replete hemodialysis patients do not require higher EPO dosages when converting from subcutaneous to intravenous administration: results of the Italian Study on Erythropoietin Converting (ISEC).
BACKGROUND
Previous studies reported significant increases in epoetin dosages when converting hemodialysis patients from subcutaneous (SC) to intravenous (IV) administration. More recent studies that corrected for iron deficiency found a much lower, if any, increase in epoetin dosage and/or decrease in hemoglobin (Hb) level after conversion from SC to IV epoetin administration. Therefore, the matter is still open for debate.


METHODS
This multicenter observational study evaluated stable hemodialysis patients without iron deficiency who had a stable SC epoetin dosage and Hb level of 10 g/dL or greater (> or =100 g/L) at the time of study enrollment. Data for epoetin dosage, anemia, and inflammatory markers were collected retrospectively during the last 6 months of SC epoetin treatment and prospectively for 6 months after conversion to IV administration. The primary efficacy assessment was difference in Hb levels and epoetin dosages between patients administered epoetin SC and IV. Changes in values for iron stores, C-reactive protein, intact parathyroid hormone, and albumin were monitored as control parameters.


RESULTS
Data were analyzed for 262 hemodialysis patients from 6 Italian centers. Overall, mean Hb levels were similar with SC and IV epoetin administration (11.49 g/dL [114.9 g/L] and 11.44 g/dL [114.4 g/L]). Mean epoetin dosages also were similar with SC and IV administration (7,185 and 7,270 IU/wk). In patients requiring epoetin dosages of 12,000 IU/wk or greater at study entry, mean dosages tended to decrease after conversion to IV administration. There were no significant changes in control parameters.


CONCLUSIONS
Conversion from SC to IV epoetin administration did not result in changes in Hb levels or epoetin dosage requirements in iron-replete hemodialysis patients.
Pizzarelli
Francesco
F
Nephrology Unit, SM Annunziata Hospital, Florence, Italy. fpizzarelli@yahoo.com
David
Salvatore
S
Sala
Patrizio
P
Icardi
Andrea
A
Casani
Aldo
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D002097:C-Reactive Protein / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007501:Iron / Q000097:blood*; D007558:Italy; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors
D006454:Hemoglobins; D010281:Parathyroid Hormone; D004921:Erythropoietin; D002097:C-Reactive Protein; D007501:Iron