Association of Erythropoietin Dose and Route of Administration with Clinical Outcomes for Patients on Hemodialysis in the United States

Abstract

Background and objectives Recombinant human erythropoietin (epoetin) is used routinely to increase blood hemoglobin levels in patients with ESRD and anemia. Although lower doses of epoetin are required to achieve equivalent hemoglobin responses when administered subcutaneously rather than intravenously, standard practice has been to administer epoetin to patients on hemodialysis intravenously. Randomized trials of alternative epoetin treatment regimens in patients with kidney failure have shown that risks of cardiovascular complications and death are related to the dose levels of epoetin used. Therefore, given the dose-sparing advantages of subcutaneous epoetin administration, the possibility that treatment of patients on hemodialysis with subcutaneous epoetin might be associated with more favorable outcomes compared with intravenous treatment was investigated.Design, setting, participants, & measurements A retrospective cohort study of 62,710 adult patients on hemodialysis treated with either intravenous or subcutaneous epoetin-a and enrolled in the Centers for Medicare and Medicaid Services ESRD Clinical Performance Measures Project from 1997 to 2005 was carried out. Risks of death and/or hospitalization for cardiovascular complications (adverse composite event outcomes) during 2 years of follow-up were determined in relationship to epoetin dose and route of administration (intravenous versus subcutaneous) by multivariate Cox proportional hazard modeling adjusted for demographics and clinical parameters.Results Epoetin doses used to achieve equivalent hemoglobin responses in study patients were, on average, 25% higher when epoetin was administered intravenously rather than subcutaneously (as expected). Moreover, adverse composite event outcomes were found to be significantly more likely to occur during follow-up for patients on hemodialysis managed with intravenous rather than subcutaneous epoetin (adjusted hazard ratio for adverse events within 1 year [intravenous versus subcutaneous] was 1.11 [95% confidence interval, 1.04 to 1.18]).Conclusions This study finds that treatment of patients on hemodialysis with subcutaneous epoetin is associated with more favorable clinical outcomes than those associated with intravenous epoetin treatment.

The Many Facets of Erythropoietin Physiologic and Metabolic Response

“…Recombinant EPO produced in Chinese hamster ovary cells yields a glycoprotein with apparent molecular weight about 34,000 that is biologically active (Recny et al, 1987). EPO received approval in 1989 from the U.S. Food and Drug Administration for clinical treatment of anemia associated with chronic renal failure due to insufficient EPO production, which has markedly improved treatment of this disease (Paoletti and Cannella, 2006;Jelkmann, 2013;Wright et al, 2015).…”

Clinical study of Shengxuening tablet combined with rHuEPO for the treatment of renal anemia of maintenance hemodialysis patients

“…Common iron supplements include oral administration type and intravenous injection type. Oral administration is low in bioavailability and intravenous injection can aggravate oxidative stress and result in a variety of complications ( 10 ).…”

Anemia in Chronic Kidney Disease and After Kidney Allotransplantation (Systematic Review)

“…Short-acting EPO can be administered to dialysis patients subcutaneously and intravenously as well, but subcutaneous administration way requires lower doses of EPO [1,20,44]. Target Hb level is considered as 100-110 g/l (Hct 30-33%) for the majority of hemodialysis (HD) patients [1,2,9,20].…”