289 Investigation of the Efficacy of Subcutaneous Versus Intravenous Erythropoietin in Obese African American Patients

Abstract

INVESTIGATION OF THE EFFICACY OF SUBCUTANEOUS VERSUS INTRAVENOUS ERYTHROPOIETIN IN OBESE AFRICAN AMERICAN PATIENTS Michael Shoemaker-Moyle, Manjunath Ramiah, Catherine Wells, Tibor Fulop, Lajos Zsom. University of Mississippi Medical Center, Jackson, MS, USA Forrest General Hospital, Hattiesburg, MS, USA To correct renal anemia, the subcutaneous (SC) route of erythropoietin (EP) administration has been associated with increased efficacy and decreased dose requirements, when compared with intravenous (IV) route. The effect of obesity as potential modifier to date is little explored. This study aims to answer the question of whether BMI influences the decrease in dose of EP when switching from IV to SC route. We performed IV to SC conversion of EP for 83 in-center dialysis patients and monitored outcomes over a 9 month period. Patients were divided into three categories based on BMI [ 35 (n=20)]. We obtained baseline demographic parameters, calculated BMI, and monitored iron saturation, ferritin, hemoglobin (Hg) along with EP requirements. Statistical analysis has been performed with SPSS v.18 with results reported either percents or means with standard deviations (SD). The cohort was all African American, 48% male with a mean age of 54 (13.3), and BMI 29.9 (7.5). Baseline iron saturation was 24.1 (10.7)%, ferritin 642.5 (280.4)ng/mL. Hg remained unchanged: 11.19 (1.32) vs. 11.33 (1.35)g/dL. Initial EP weekly dose for the entire cohort was 20, 658 (17,398) units (U): final dose 18,400 (16,426)U, with close correlation between initial and final doses (r 0.627; p<0.001). Weekly EP dose remained virtually unchanged in BMI category 1 and 2 [(15,880(14,339) vs. 14,695(13,858); 20,891(13,574) vs. 20,364(15,112)] but decreased in the category 3: 26,200(24,883) vs. 19,057(21,243). However, BMI had no independent effect in linear regression modeling with multiple covariates (age, BMI; age, BMI, iron saturation, ferritin) included (p=ns). In conclusion, obesity may affect relative efficacy of EP conversion; additional studies may be needed.