BACKGROUND: Compared to the intravenous route, subcutaneous administration of epoetin requires lower dose and will be an attractive option for cost containment when bundling for dialysis is implemented. Hemoglobin variability defined as fluctuation of hemoglobin over time has not been well studied with respect to the route of administration. METHODS:157 prevalent-hemodialysis subjects were analyzed from an open-label, randomized study that compared the intravenous to the subcutaneous route of epoetin with identical weight-based dosing algorithm. Hemoglobin variability was defined as the number of weeks hemoglobin is outside the target range of 10-11 g/dl. Sensitivity analysis was performed. RESULTS:78 subjects in the intravenous and 79 in the subcutaneous group entered the 24-week dose maintenance phase. Baseline covariates were similar in both groups except for the dose of epoetin (lower in subcutaneous) and dialysis vintage (longer in intravenous). Patients on subcutaneous epoetin were outside the target range more weeks (p = 0.04) and had higher standard deviation of hemoglobin (p = 0.01) compared to the intravenous group. CONCLUSIONS: The subcutaneous route of epoetin was associated with modestly higher hemoglobin variability, probably reflecting greater sensitivity of the subcutaneous route and/or identical epoetin-dosing algorithm employed in both the arms. This study could serve as an important guide when bundling for dialysis services is implemented as switching from intravenous to subcutaneous administration is likely to occur. (c) 2008 S. Karger AG, Basel.
RCT Entities:
BACKGROUND: Compared to the intravenous route, subcutaneous administration of epoetin requires lower dose and will be an attractive option for cost containment when bundling for dialysis is implemented. Hemoglobin variability defined as fluctuation of hemoglobin over time has not been well studied with respect to the route of administration. METHODS: 157 prevalent-hemodialysis subjects were analyzed from an open-label, randomized study that compared the intravenous to the subcutaneous route of epoetin with identical weight-based dosing algorithm. Hemoglobin variability was defined as the number of weeks hemoglobin is outside the target range of 10-11 g/dl. Sensitivity analysis was performed. RESULTS: 78 subjects in the intravenous and 79 in the subcutaneous group entered the 24-week dose maintenance phase. Baseline covariates were similar in both groups except for the dose of epoetin (lower in subcutaneous) and dialysis vintage (longer in intravenous). Patients on subcutaneous epoetin were outside the target range more weeks (p = 0.04) and had higher standard deviation of hemoglobin (p = 0.01) compared to the intravenous group. CONCLUSIONS: The subcutaneous route of epoetin was associated with modestly higher hemoglobin variability, probably reflecting greater sensitivity of the subcutaneous route and/or identical epoetin-dosing algorithm employed in both the arms. This study could serve as an important guide when bundling for dialysis services is implemented as switching from intravenous to subcutaneous administration is likely to occur. (c) 2008 S. Karger AG, Basel.
Authors: Denise M Hynes; Kevin T Stroupe; Joel W Greer; Domenic J Reda; Diane L Frankenfield; James S Kaufman; William G Henderson; William F Owen; Michael V Rocco; Jay B Wish; Jeffery Kang; John R Feussner Journal: Am J Med Date: 2002-02-15 Impact factor: 4.965
Authors: J S Kaufman; D J Reda; C L Fye; D S Goldfarb; W G Henderson; J G Kleinman; C A Vaamonde Journal: N Engl J Med Date: 1998-08-27 Impact factor: 91.245
Authors: Steven M Brunelli; Marshall M Joffe; Rubeen K Israni; Wei Yang; Steven Fishbane; Jeffrey S Berns; Harold I Feldman Journal: Clin J Am Soc Nephrol Date: 2008-03-12 Impact factor: 8.237