Starting r-HuEPO in chronic renal failure: when, why, and how?

Administration of recombinant human erythropoietin (r-HuEPO) in uraemic pre-dialysis patients is both effective and safe. The benefits are similar to those in dialysis patients: a marked increase in subjective wellbeing and ability to perform physical work. There is a strong argument for treating on the basis of anaemic symptoms, rather than on absolute haematocrit or haemoglobin. Some 30-40% of r-HuEPO-treated pre-dialysis patients may need initiation of, or an increase in, antihypertensive therapy. Provided blood pressure is carefully controlled, r-HuEPO does not appear to accelerate the progression of renal failure, and there is preliminary evidence that it may even delay the need for dialysis in children and possibly in adults. Subcutaneous self-administration is convenient for most pre-dialysis patients; once weekly administration can yield effective results and may enhance patient compliance. As in dialysis patients, detection and correction of iron deficiency play an essential role in maximizing the success of r-HuEPO administration. For most pre-dialysis patients, oral iron administration is convenient, and absorption is satisfactory.