Drug usage evaluation of epoetin in chronic renal failure

All patients (48) followed by the chronic dialysis program on either peritoneal dialysis or incenter hemodialysis who received epoetin were included in this 1 year retrospective study. Variables evaluated included appropriateness of patient selection, drug dosage, monitoring of epoetin therapy as well as treatment outcome, incidence of side effects, cost versus reimbursement of epoetin, and need for iron supplementation. The target hematocrit of 30 to 36% was reached by 84.6% of patients. The difference between the baseline and treatment hematocrits was statistically significant (p less than 0.01). The average number of transfusions dropped significantly from 0.66 to 0.11 per patient per month (p less than 0.01) and the mean percentage of cytotoxic panel reactivity antibody was also significantly reduced (p less than 0.01) during treatment with epoetin. Serious side effects of epoetin therapy were rare, but four hemodialysis patients experienced five episodes of clotted accesses. The incidence of hypertension requiring addition or change of antihypertensive medication was 17.1%. No seizures were observed during the study period. The results of this study also revealed that more careful attention to iron status was needed during the period of data collection. A nomogram for prediction of iron need based on initial hemoglobin and ferritin levels was also studied and found to be accurate in 87.5% of patients.