[QuiPO: who inject EPO?]

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.

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.

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).

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.