Subcutaneous compared with intravenous epoetin treatment in patients on hemodialysis: one center study

The use of epoetin has, in Europe, been restricted to the intravenous (i.v.) route in patients on hemodialysis. This study is aimed at investigating impacts of this change in policy. We retrospectively compared 45 hemodialysis patients treated with epoetin (alpha, beta) subcutaneously (subcutaneous [s.c.] period) for 12 months before and 12 months after changing the route from s.c. to i.v., and 38 patients of the i.v. period who underwent long-term, i.v. low-dose iron therapy (i.v. iron period) for 6 months. During the study period, the dose of epoetin increased in the i.v. period compared to the s.c. period by 6.4% (7379 +/- 3556 IU/week [median 7846] vs 6907 +/- 3842 IU/week [median 5846], respectively [NS]). During the i.v. iron period, patients began to receive regular i.v. iron. The postiron epoetin dose was 5923 +/- 4779 IU/week (median 4500). The dose was decreased in comparison with the s.c. and i.v. periods by 14.2% and 19.7%, respectively. Hemoglobin decreased in the i.v. period compared to the s.c. period (120.4 +/- 8.0 g/L vs 123.5 +/- 6.7 g/L [P < 0.01]), and increased in the i.v. iron period compared to the s.c. and i.v. periods ([126.5 +/- 9.9 g/L vs 123.5 +/- 6.7 [P < 0.01]), and vs 120.4 +/- 8.0 (P < 0.01)]. Changing the route of administration of epoetin required an insignificant increase in dosage. Regular low-dose iron improves the response to epoetin and lowers the dose of epoetin, even in cases when the intravenously administration route is used.