[Treatment with erythropoietin in Central and Eastern Europe]

Human recombinant erythropoietin (r-HuEpo) was introduced widely to the clinical practice more than ten years ago. In many countries belonging to Central and Eastern Europe (CEE) use of this drug was very delayed mainly due to the high costs of treatment. The aim of the presented study was to estimate actual possibilities of r-HuEpo administration in thirteen CEE countries. Survey was performed using especially prepared questionnaires including questions connected with r-HuEpo and filled out by the members of the Central and Eastern Advisory Board in Chronic Renal Failure. Below mentioned numbers of patients were under the control of the responders during performing the survey: on hemodialysis (HD) 1119, on peritoneal dialysis (PD) 205 and 1556 after renal transplantation (RT). Respectively in subsequent groups 53.5% (HD), 41.5% (PD) and 16.2 (RT) of patients were treated using r-HuEpo. Possibilities of treatment differs significantly between two groups of countries. In those with better developed economy (Croatia, Czech, Hungary, Macedonia, Poland, Slovakia, Slovenia, Yugoslavia) 60-70% of dialysed patients were given r-HuEpo and in the rest of countries (Bulgaria, Latvia, Lithuania, Romania, Russia) this drug was administered in 10-35% of patients. The most popular way of the r-HuEpo administration were subcutaneous injections (89.3%) comparing with only 10.7% of patients getting this important hormone intravenously. Average weekly dose of r-HuEpo was 71-90 IU/kg/week in so treated patients and 91-100 IU/kg/week in whom drug was administered i.v., in majority of patients two or three times weekly. Major part of responders tried to achieve as the optimal level of Hb 10-12 g/dl but simultaneously in 1/3 of centres only achieving of the Hb level 9-10 g/dl was possible. The general majority of responders were not satisfied with the obtained results and recognised economical constrains as the main reason of such a situation. These problems were more widely observed in predialysis patients, because only few of them were on r-HuEpo treatment. Side effects of this drug expressed rarely and main of them were development or acceleration of hypertension (16%) and thrombotic complications in the vascular access (8%). The main cause of hyporesponsiveness to drug was iron deficit despite of the adequate monitoring of responders were convinced that further avoiding of economical constrains would be benefit dialysis and predialysis patients. It is especially important looking on the literature finding supported by personal experience showing that r-HuEpo was positive impact on the quality of life, status of the cardiovascular system, endocrine, metabolic and immunological disorders observed in uremic patients.