Continuous intravenous intradialysis versus intravenous postdialysis erythropoietin therapy in chronic haemodialysis patients: a randomized, controlled, crossover study

Background: Subcutaneous recombinant humanerythropoietin seems to be more effective than intravenous administration.Local pain, however, may diminish patient compliance with the subcutaneousroute. Recently continuous intravenous intradialysis administration ofrHuEpo has been reported to be more efficacious in stimulatingerythropoiesis than the usual postdialysis intravenous bolus.Methods: We conducted a randomized, controlled,crossover study on stable chronic haemodialysis patients to compare theefficacy of continuous intradialysis rHuEpo therapy with intravenouspostdialysis administration. Twenty patients were selected and randomlyassigned to receive rHuEpo either postdialysis (control phase) or bycontinuous intradialysis perfusion (slow Epo phase) for 12 weeks. Afterthis period, patients were switched to the alternative method for 12additional weeks. The erythropoietin dose remained unchanged during thestudy. Haematocrit was monitored weekly and iron metabolism, serum Epo, andvitamins were measured monthly. Urea kinetics and iPTH measurements wereperformed every 3 months. Results: Three patients wereexcluded because of unrelated problems. The final mean haematocrit wasunchanged from previous basal values in both phases and no statisticaldifferences were found for any parameter between the groups. No differenceswere found in iron metabolism nor in urea kinetic parameters.Conclusions: Continuous intravenous intradialysisadministration of rHuEpo is no more effective than an intravenouspostdialysis bolus as rHuEpo maintenance therapy in stable chronichaemodialysis patients.