The Journal of Informed Pharmacotherapy 2002;11:413.
Anne Sawoniak, B.Sc.(Pharm), Karen Shalansky, Pharm. D., FCSHP, J. Jastrzebski, MD, FRCP
Pharmaceutical Sciences Clinical Service Unit and the Department of Nephrology, Vancouver General Hospital , Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada
Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 8, 2002.
Erythropoietin (EPO) is given for long-term management of serum hemoglobin (Hgb) in hemodialysis (HD) patients at a typical dose of 50-300U/kg/week. Our objectives were to assess risk factors for HD patients receiving EPO doses greater than 300U/kg/week (EPO-resistant) and to determine the effect of downward EPO dosage adjustments on Hgb.
A major Canadian tertiary adult acute care teaching hospital.
This was an 8-month prospective, open-label study of 19 EPO-resistant patients drawn from a 160-bed HD unit. Hgb, iron studies, intact parathyroid hormone, folate, B12, aluminum, reticulocyte counts and HD flow adequacy were determined at baseline. The former three parameters were followed every 6, 12, and 26 weeks, respectively. Target Hgb was 120-135g/L. Factors contributing to EPO resistance were assessed and treated every 6 weeks, if possible. Downward EPO dosage adjustments of 12.5-25% to the closest 1000U were considered if underlying causes of EPO resistance could not be identified or reversed, or if Hgb rose beyond the target.
Dysfunctional vascular access and iron deficiency were the predominant treatable factors associated with EPO resistance. By study end, mean EPO dosage decreased significantly from 469U/kg/week to 319U/kg/week and mean Hgb increased significantly from 106g/L to 116g/L. The percent of EPO-resistant patients with a Hgb in the target range rose from 16% at baseline to 63%. Annual cost savings approximated $157,000.00.
A structured multidisciplinary approach to the management of EPO-resistant patients was successful in significantly lowering EPO dosage with improvement in serum Hgb at a substantial cost savings.
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