Increased erythropoietin-α dose when switching from subcutaneous to intravenous administration: effect of serum albumin

Abstract

Patients on hemodialysis receiving subcutaneous (s.c.) erythropoietin usually require a higher dose if switched to intravenous (i.v.) administration. The factors affecting this dose change are not clear. From January 2003 to June 2004, patients on hemodialysis who were receiving s.c. erythropoietin were enrolled in this prospective observational study. The s.c. route was continued for the first 2 months and the average weekly dose of erythropoietin to maintain the target hematocrit from that period was the baseline dose. Patients were then switched to i.v. erythropoietin and followed for 6 months, with the dose adjusted monthly to maintain the hematocrit. Biochemistry data were collected throughout the study period. After 6 months, the mean i.v. dose of erythropoietin in 179 patients was 50.9% higher than baseline. The 86 patients requiring a >50% increase had a significantly lower serum albumin than 93 patients with a <50% increase in dose (3.64 g/dl vs. 3.78 g/dl, p<0.005). Each 1 g/dl higher level of serum albumin was associated with a 1237-U lower dose increment (F = 12.47, p<0.001). Serum albumin is significantly correlated with the increase in erythropoietin dose needed when switching from s.c. to i.v. administration in Taiwanese on hemodialysis.