Intraperitoneal erythropoietin treatment of children with chronic renal failure

Steele, Brian T.; Vigneux, Annette

doi:10.1007/bf02254214

Cited by 5 publications

(1 citation statement)

References 7 publications

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“…While virtually all PD patients receive epoetin alfa subcutaneously (SC), numerous studies have examined the pharmacokinetics and efficacy of intraperitoneal (IP) administration of this drug (2)(3)(4)(5)(6). Recent data suggest IP dosing can lead to adequate drug absorption and efficacy if epoetin alfa is administered into an empty peritoneal cavity (3,(7)(8)(9)(10). Comparison of SC and IP administration of equivalent doses of epoetin alfa has revealed that similar peak plasma concentrations of the drug are achieved if the IP dose is instilled into a "dry" peritoneum for 4 hours (3).…”

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confidence: 99%

Comparison of Intraperitoneal and Subcutaneous Epoetin Alfa in Peritoneal Dialysis Patients

et al. 1999

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Objective To compare the efficacy of intraperitoneal (IP) and subcutaneous (SC) administration of epoetin alfa in patients receiving peritoneal dialysis (PD). Design A 32-week prospective, randomized, cross-over experimental design. Setting Two university-based outpatient PD centers. Patients Twenty adult PD patients receiving stable doses of SC epoetin alfa enrolled in the study. Thirteen patients completed 32 weeks of follow-up. Intervention Patients were randomly assigned to receive either SC or IP epoetin alfa at the start of the study. Dose adjustments were made to maintain baseline hematocrit ± 3 percentage points. Following 16 weeks of treatment, patients crossed over to the other route of administration for an additional 16 weeks. Intraperitoneal epoetin alfa was administered into an empty peritoneal cavity for approximately 8 hours before resuming dialysis. End-of-study IP epoetin alfa doses required to maintain target hematocrit were given twice weekly ( n = 1), once weekly ( n = 11), or once every other week ( n = 1). All patients received iron supplements to maintain or exceed prestudy iron parameters. Main Outcome Measure Prior to the study, the primary outcome measure was defined as the difference in epoetin alfa dose between IP and SC administration. Results Thirteen patients completed the study. The area under the dosing-requirement curve for IP epoetin alfa was larger than for SC administration ( p = 0.0029), and the slope of the 16-week dose-requirement curve was greater for IP administration ( p = 0.017), suggesting greater dose stability for SC administration. Paired analysis indicated greater IP intrapatient dose requirements ( p < 0.0001). The mean difference in SC versus IP doses was 5000 ± 1510 units per week. Some patients required escalating IP doses to maintain target hematocrit values. Iron administration and iron stores were similar in both groups. Conclusion Intraperitoneal epoetin alfa may be a suitable alternative for some patients for whom SC dosing is undesirable. Large IP versus SC dosing differences noted in a few patients are unexplained, but may result from interpatient variability in IP epoetin alfa absorption. Intraperitoneal dosing into an empty peritoneum can be done safely and effectively.

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confidence: 99%

Comparison of Intraperitoneal and Subcutaneous Epoetin Alfa in Peritoneal Dialysis Patients

et al. 1999

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Intraperitoneal erythropoietin in children on peritoneal dialysis: A study of pharmacokinetics and efficacy

Kausz

Watkins

Hansen

et al. 1999

American Journal of Kidney Diseases

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Use of erythropoiesis-stimulating agents in children with chronic kidney disease: a systematic review

Bruce

Schulga

Reynolds

2022

Clinical Kidney Journal

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Background and objectives Erythropoiesis-stimulating agents (ESAs) revolutionised the management of anaemia in chronic kidney disease (CKD) when introduced in the late 1980s. A range of ESA types, preparations and administration modalities now exist, with newer agents requiring less frequent administration. Though systematic reviews and meta-analyses have been published in adults, no systematic review has been conducted investigating ESAs in children. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement for the conduct of systematic reviews was used. All available literature on outcomes relating to ESAs in children with CKD was sought. A search of MEDLINE, CINAHL and EMBASE databases were conducted by two independent reviewers. Inclusion criteria were: published trials in English; children with chronic and end-stage kidney disease; use of any ESA studied against any outcome measure. An assessment of risk of bias was carried out on all included randomised trials using the criteria from the Cochrane handbook for systematic reviews of interventions. Two tables were used for data extraction for randomised and observational studies. Study type, participants, inclusion criteria, case characteristics, follow up duration, ESA type and dosage, interventions and outcomes were extracted by one author. Results Of 965 identified articles, 58 were included covering 54 cohorts. 6 were randomised trials and 48 were observational studies. 38 studies assessed the efficacy of recombinant human erythropoietin (rHuEPO), 11 of darbepoetin (DA), and 3 of continuous erythropoietin receptor activator (CERA), with 6 studies appraising secondary outcome measures exclusively. Recruitment to studies was a consistent challenge. The commonest adverse effect was hypertension, though confounding effects often limited direct correlation. Two large cohort studies demonstrated a higher hazard of death independently associated with high ESA dose. Secondary outcome measures included quality of life measures, growth and nutrition, exercise capacity, injection site pain, cardiovascular function, intelligent quotient (IQ), evoked potentials, and platelet function. Conclusions All ESA preparations and modes of administration were efficacious, with evidence of harm at higher doses. Evidence supports individualising treatments with strong consideration given to alternate treatments in patients who appear resistant to ESA therapy. Further research should focus on randomised trials comparing the efficacy of different preparations, treatment options in apparently ESA resistant cohorts and clarification of meaningful secondary outcomes to consolidate patient-relevant indices.

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Intraperitoneal erythropoietin treatment of children with chronic renal failure

Cited by 5 publications

References 7 publications

Comparison of Intraperitoneal and Subcutaneous Epoetin Alfa in Peritoneal Dialysis Patients

Comparison of Intraperitoneal and Subcutaneous Epoetin Alfa in Peritoneal Dialysis Patients

Intraperitoneal erythropoietin in children on peritoneal dialysis: A study of pharmacokinetics and efficacy

Use of erythropoiesis-stimulating agents in children with chronic kidney disease: a systematic review

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