Abstract
Aims: To correct renal anemia, subcutaneous (SC) route of recombinant human erythropoietin (rhuEPO) administration has been associated with increased efficacy and decreased dose requirements, when compared with intravenous (IV) route. The effect of obesity as a potential modifier during rhuEPO administration has not been well explored. Study Design: Single-center, Longitudinal Cohort Study. Place and Duration of Study: University of Mississippi Medical Center Outpatient Dialysis Unit, between February and November of 2009. Research Article British Journal of Medicine & Medical Research, 4(1): 184-193, 2014 185 Methodology: We performed IV to SC rhuEPO conversion for 86 in-center dialysis patients and, following a six-month equilibration period, we monitored outcomes over a period of three months. We obtained baseline demographic parameters, calculated Body Mass Index (BMI) and monitored iron saturation, ferritin, hemoglobin (Hgb) along with rhuEPO requirements. Patients were divided into 3 categories based on BMI [ 35 (n= 21) kg/m]. Results are reported either as percents, means with SD or median with 25-75% interquartile range, as appropriate. Results: The cohort was all African-American, 48.8% male, aged 54.7 (13.3) years and BMI calculated at 29.9 (7.4) kg/m. Baseline iron saturation was 24 (10.6)%, ferritin measured 641 (277) ng/mL. Hgb remained unchanged during the observation period: 11.1 (1.3) vs. 11.2 (1.3) gm/dL. Initial rhuEPO weekly dose for the entire cohort was 19,729 (17,448) Units/week (U/week); final dose 17,482 (14,860) U/week, with close correlation between initial and final doses (r: 0.653, P<0.0001). Weekly rhuEPO dose remained virtually unchanged in BMI categories 1 and 2 [13,927 (10,938) vs. 13,297 (10,247) U/week; 20,684 (15,788) vs. 20,997 (17.917)] (P=NS for both) but decreased in the category 3: 25,459 (24,403) vs. 16,444 (12,749) (P=0.081). However, BMI had no independent effect in linear regression modeling with multiple covariates (age, BMI, iron saturation, ferritin) included. Conclusion: Obesity may affect relative efficacy of rhuEPO conversion; additional studies may be needed.
Highlights
Successful management of chronic renal insufficiency involves addressing multiple metabolic abnormalities, including correction of renal anemia and relative erythropoietin deficiency with recombinant human erythropoietin administration [1,2]
The recent change of U.S Center for Medicare and Medicaid Services (CMS) reimbursement arrangement may have removed the incentives for administering excessive doses of recombinant human erythropoietin (rhuEPO) for financial gains in dialysis units of the U.S These rules eliminated the separate payment for injectables and created a “bundled” payment for all services related to endstage renal disease (ESRD) into a single payment entity
Our study aimed to answer the question whether Body Mass Index (BMI) could potentially influence the reduction of rhuEPO dosing during conversion from the IV to the SC route
Summary
Successful management of chronic renal insufficiency involves addressing multiple metabolic abnormalities, including correction of renal anemia and relative erythropoietin deficiency with recombinant human erythropoietin (rhuEPO) administration [1,2]. The most common route of rhuEPO administration in United States is the intravenous (IV) route, in keeping with KDOQI guidelines favoring IV administration for patient convenience. IV conversion has been associated with increased rhuEPO and intravenous iron requirements [3] and up to 30% less total dosing of rhuEPO might be required to achieve identical hemoglobin (Hgb) goals via subcutaneous (SC) route [4,5]. Concerns regarding worsening BP control with rhuEPO administration, especially via IV route, persist in the medical literature [8,9]. Our study aimed to answer the question whether Body Mass Index (BMI) could potentially influence the reduction of rhuEPO dosing during conversion from the IV to the SC route. Our theory was that such dose reduction will vary between defined BMI categories
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