title: Route of epoetin administration influences hemoglobin variability in hemodialysis patients.
abstract: BACKGROUND
  Compared to the intravenous route, subcutaneous administration of epoetin requires lower dose and will be an attractive option for cost containment when bundling for dialysis is implemented. Hemoglobin variability defined as fluctuation of hemoglobin over time has not been well studied with respect to the route of administration.
  
  
  METHODS
  157 prevalent-hemodialysis subjects were analyzed from an open-label, randomized study that compared the intravenous to the subcutaneous route of epoetin with identical weight-based dosing algorithm. Hemoglobin variability was defined as the number of weeks hemoglobin is outside the target range of 10-11 g/dl. Sensitivity analysis was performed.
  
  
  RESULTS
  78 subjects in the intravenous and 79 in the subcutaneous group entered the 24-week dose maintenance phase. Baseline covariates were similar in both groups except for the dose of epoetin (lower in subcutaneous) and dialysis vintage (longer in intravenous). Patients on subcutaneous epoetin were outside the target range more weeks (p = 0.04) and had higher standard deviation of hemoglobin (p = 0.01) compared to the intravenous group.
  
  
  CONCLUSIONS
  The subcutaneous route of epoetin was associated with modestly higher hemoglobin variability, probably reflecting greater sensitivity of the subcutaneous route and/or identical epoetin-dosing algorithm employed in both the arms. This study could serve as an important guide when bundling for dialysis services is implemented as switching from intravenous to subcutaneous administration is likely to occur.
authors.affiliation: Cooperative Studies Program Coordinating Center, Hines VA Hospital, Hines, IL, USA.
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
authors.forename: Angie
authors.initials: A
authors.lastname: Hirter
authors.forename: James
authors.initials: J
authors.lastname: Kaufman
authors.forename: Sai Ram
authors.initials: SR
authors.lastname: Keithi-Reddy
authors.forename: Domenic
authors.initials: D
authors.lastname: Reda
authors.forename: Ajay
authors.initials: A
authors.lastname: Singh
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D006435:Renal Dialysis
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa