title: [QuiPO: who inject EPO?].
abstract: BACKGROUND
  Erythropoiesis Stimulating Agents (ESA) are largely prescribed before dialysis stage to chronic kidney disease patients. In accordance to current international guidelines, lots have been made by pharmacological companies in order to improve self management of ESAs: subcutaneaous administration, pencil devices, mutidose cartridges, low injection volume, very fine needles, once a month injections but none is currently known on the percentage of patients who actually do self administration of ESAs.
  
  
  METHODS
  We conducted a simple prospective questionnaire study in different nephrology departments in France, on pre-dialysis patients. Questionnaires have been fulfilled by randomly selected French nephrologists during visits with outpatients treated by ESA. Costs have been evaluated by ESA and nurse visit direct costs in euros and compared by a Wilcoxon test.
  
  
  RESULTS
  Within 6 months, 143 questionnaires of outpatients have been completed. The characteristics of the population are as followed: 53% men, mean age 66.4±16.9 y/o, 38.6% of diabetics, mean estimated Glomerular Filtration Rate (eGFR by MDRD formula) 22.8±11.6 mL/min/1.73 m(2). ESAs are prescribed as follow: Aranesp(®) (50.3%), Mircera(®) (36.3%), NeoRecormon(®) (10.5%), Eprex(®) (2.1%) and Retacrit(®) (0.7%). ESA self administration concerns only 24.8% of the patients their while most of the patients (70.2%) ask a nurse for injection without any differences between ESAs (P=0.24), sex (P=0.81) or presence of diabetes (P=0.78). ESA self administration is more frequent for working patients (56.8% versus 34.7%; P=0.0002). Moreover, for 86.7% of the patients, nurse comes at home and in 60% of the cases only for this injection. Finally, 42% of the patients feel improvement as soon as a couple of hours after injection whatever ESA used (0-45 days). In addition, mean haemoglobin level is 11.4±1.3g/dL, mean ferritinemia is 229±211UI/mL. Non surprisingly, nurse injection regimen is more expensive than self injection (P=0.0016).
  
  
  CONCLUSIONS
  This simple questionnaire shows that despite efforts made to improve ESA self administration, a minority of patients are in fact proceeding to ESA self administration. Asking for a nurse, does not help patient to be independent, and increases health cost. Efforts have to be made in order to help patients for ESA self administration.
authors.affiliation: Service de néphrologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France; Université Rennes 1, 2, rue Léon-Bernard, 35000 Rennes, France. Electronic address: cecile.vigneau@chu-rennes.fr.
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.affiliation: Service de néphrologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Le Stum
authors.affiliation: Service de néphrologie, groupe hospitalier Pitié-Salpêtrière, 43-87, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Isnard-Bagnis
authors.affiliation: Service de néphrologie, CHU d'Amiens-Picardie, 16, rue Fernel, 80000 Amiens, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Choukroun
authors.affiliation: Service de néphrologie, CHU La Cavale Blanche, 2, avenue Foch, 29200 Brest, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Lemeur
authors.affiliation: Service de néphrologie, CHU Rangueil, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.affiliation: Université Rennes 1, 2, rue Léon-Bernard, 35000 Rennes, France; Service de néphrologie, groupe hospitalier Pitié-Salpêtrière, 43-87, boulevard de l'Hôpital, 75013 Paris, France; Service de néphrologie, CHU d'Amiens-Picardie, 16, rue Fernel, 80000 Amiens, France; Service de néphrologie, CHU La Cavale Blanche, 2, avenue Foch, 29200 Brest, France; Service de néphrologie, CHU Rangueil, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France; Service de pharmacologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012646:Self Administration / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D006397:Hematinics
keywords: ASE; Auto-injections; ESA; Infirmière; Nurse; Patient