Recombinant human erythropoietin therapy in haemodialysis patients--dose determination and clinical experience.

Recombinant human erythropoietin (R-Hu-EPO) was given to stable, long-term haemodialysis patients with haematocrit less than or equal to 25% who required no blood transfusions. Thirteen patients were initially given R-Hu-EPO at 24 U/kg i.v. at the end of each dialysis session, with a doubling of the dose every second week until a dose of 96 U/kg (n = 6) or 192 U/kg (n = 7) was reached after 8 weeks. In addition, three patients were given 24 U/kg for 2 weeks and subsequently 48 U/kg for 14 weeks. Median haematocrit increased from 19.4% (14.8-24.3) to 30.0% and 32.5% with 96 or 192 U/kg respectively. Starting 7 days after R-Hu-EPO a log dose-dependent increase in reticulocyte counts was noted. A consistent decrease in ferritin concentrations was observed despite oral supplementation of iron. A continuous rise in platelet counts was noted. Irrespective of blood-pressure status, predialysis blood pressure increased in six of nine patients who were not on antihypertensive medication; increased antihypertensive therapy was required in the others. A rise in bilirubin within the normal range was seen at the end of the study. No severe clinical side-effects occurred; specifically, there were no thrombotic episodes with the exception of clotting of two fistulae with known stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)