Case management of the anemic patient. Epoetin alfa: focus on kinetic dosing

Epoetin alfa (EPOGEN, recombinant human erythropoietin) has proven to be a major therapeutic advance in treating the chronic refractory anemia associated with end-stage renal disease (ESRD). As with many medications, the dose of Epoetin alfa must be individualized for each patient. In order to elicit a consistent production of red cells from the bone marrow, it is desirable that dose modifications be made as infrequently as possible. Gotch and Uehlinger have developed a kinetic model that can limit dose modifications by predicting the optimal dose of Epoetin alfa for each patient. Termed the Erythrokinetic Model, it compares individual patient response to Epoetin alfa to the life cycle of a red blood cell. This article describes the Gotch/Uehlinger Erythrokinetic Model and uses it to gauge the clinical response of 2 patients to Epoetin alfa.