Pharmacokinetics of Intravenous, Intraperitoneal, and Subcutaneous Recombinant Erythropoietin in Patients on CAPD

Macdougall, Iain C.; Roberts, David E.; Neubert, Peter; Dharmasena, Aruna; Coles, Gerald A.; Williams, Julie

doi:10.1159/000417887

Cited by 27 publications

(11 citation statements)

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“…The pharmacokinetic data after single intravenous and single subcutaneous rhEPO administration as well as the differences between the two routes of rhEPO treatment found confirm our own results [8] and those of others [7,[10][11][12] published recently. Also, faof39% after subcutaneous rhEPO administration is between 22 and 49% [7,8,10,17,18].…”

Section: Discussionsupporting

confidence: 91%

Pharmacokinetics of Recombinant Human Erythropoietin in Dialysis Patients after Single and Multiple Subcutaneous Administrations

Kampf

Eckardt

Fischer

et al. 1992

Nephron

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The pharmacokinetics of recombinant human erythropoietin (rhEPO) were evaluated after single intravenous and single subcutaneous administration of 40 U/kg to 8 patients with dialysis treatment. All patients suffered from renal anemia with a hematocrit ≤ 24% and were treated with 40 U/kg rhEPO subcutaneously, three times a week for 6 weeks. At the end of the treatment period, kinetics of rhEPO were repeated. After the initial subcutaneous rhEPO dose, the following results were obtained: maximum plasma concentration 39.5 (26.7-56.9) U/l, area under the curve (AUC) 1,122 (582-3,220) U · h · 1^-1 and terminal half-life 13.2 (2.6-53.1) h. The corresponding data after multiple rhEPO doses were: maximum rhEPO plasma concentration 26.3 (9.4–49.1) U/l, AUC 724 (407–1,464) U·h·H and terminal half-life 14.2 (3.5-24.4) h. There were no statistical significant differences between the two investigations. From the present study, it can be concluded that after a treatment period of 6 weeks with multiple subcutaneous rhEPO doses, rhEPO absorption as well as rhEPO elimination are unchanged.

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Section: Discussionsupporting

confidence: 91%

Pharmacokinetics of Recombinant Human Erythropoietin in Dialysis Patients after Single and Multiple Subcutaneous Administrations

Kampf

Eckardt

Fischer

et al. 1992

Nephron

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“…After 5-7 h of intravenous EPOrHu administration, an intense stimulus to blood cell production is induced in bone marrow [28] and, hypothetically, the proximity between iron administration in a continuous form and EPOrHu injections (three times a week) might, through a peak saturation of transferrin, offer a higher quantitiy of iron to marrow in a period where demand is large. Nevertheless, the increment of %HypoE obtained in our study which probably reflects a functional iron deficiency status does not seem to support the idea that a high erythropoi-etic activity is linked to a more efficacious arrival of iron to marrow.…”

Section: Discussionmentioning

confidence: 99%

Continuous Intravenous Sodium Ferric Gluconate Improves Efficacy in the Maintenance Phase of EPOrHu Administration in Hemodialysis Patients

Bolaños

Castro²,

Falcón

et al. 2002

Am J Nephrol

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Although intravenous iron has proved to optimize the efficacy of EPOrHu in hemodialysis patients, hitherto no consensus exists with respect to the best regimen of intravenous iron administration. We started a prospective randomized study in 26 patients undergoing chronic hemodialysis who had adequate iron metabolism indices (serum ferritin >100 µg/l; %TSAT >20%; %HypoE <10% and CHr >26 pg) and were in the maintenance phase of EPOrHu administration (target hemoglobin obtained >10 g/dl). All patients were receiving sodium ferric gluconate (Ferrlecit^®) intermittently prior to the study and after a 1-month wash-out period where iron was not administered patients were randomized to receive the same previous dose of intravenous iron either in a continuous (6.25–21.3 mg in every hemodialysis session) or an intermittent regimen (62.5 mg every 1–4 weeks, not modifying the previous schedule of administration). At 16 weeks, the continuous group showed a significant increment in serum Hb (11.83 ± 1.12 g/dl) with respect to baseline (10.96 ± 1.31 g/dl) (p < 0.05), whereas no differences were obtained in intermittent group (baseline: 11.16 ± 1.03 g/dl; 16 weeks: 11.14 ± 0.90 g/dl, NS). In contrast with the intermittent group, serum ferritin increased significantly in the continuous group (16 weeks: 508 ± 157 µg/l; baseline: 368 ± 56 µg/l; p < 0.05), whereas %TSAT and CHr did not modified during the study in both groups. %HypoE increased significantly with respect to baseline values in the continuous group (p < 0.05) and close to significantly different in the intermittent group (p = 0.06). Our study suggests that hemodialysis patients in the maintenance phase of EPOrHu administration would obtain further benefit in terms of serum hemoglobin level with a continuous intravenous serum ferric gluconate regimen, at least in the short term.

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“…Non-dialysis CKD patients with preserved GFR, or those undergoing peritoneal dialysis, benefit from SC administration of ESAs, considering that it's least invasive and can be carried out without any monitoring. Furthermore, intraperitoneal administration in patients on continuous ambulatory peritoneal dialysis (CAPD), can dilute ESA concentration, limiting its use [34,35]. The advantage of IV administration lies in the fact that it can be conveniently administered during the process of haemodialysis.…”

Section: Route Of Administration and Stage Of Ckd (Non-dialysis Depenmentioning

confidence: 99%

Erythropoietin Administration for Anemia Due to Chronic Kidney Disease - Subcutaneous OR Intravenous, What Do We Know So Far?

Shahab

Khan

2020

Cureus

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The prevalence of anemia in chronic kidney disease (CKD) patients is almost twice that of the normal population and its severity increases exponentially as the disease worsens, dramatically affecting the quality of an individual's life. The advent of erythropoiesis stimulating agents (ESA) in the 1980s saw a revolutionary change in the treatment of anemia in CKD patients, drastically improving quality of life (QoL), overall health and reducing the need for blood transfusions. Numerous ESAs have been developed ever since and are in current use, with the primary routes of administration being intravenous (IV) and subcutaneous (SC) injections. Their use, however, has stirred significant controversy over the last two decades. Additionally, despite numerous studies and trials, the latest international recommendations for their use do not provide clear cut guidance with well-grounded evidence on the recommended route of administration for different sets of patients. Instead, this decision has mainly been left up to the physician's discretion, whilst keeping certain key factors in mind. This review shall summarize, discuss and compare the findings of previous studies on various factors governing the two aforementioned routes of administration and identify areas that need further exploration.

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Pharmacokinetics of Intravenous, Intraperitoneal, and Subcutaneous Recombinant Erythropoietin in Patients on CAPD

Cited by 27 publications

References 0 publications

Pharmacokinetics of Recombinant Human Erythropoietin in Dialysis Patients after Single and Multiple Subcutaneous Administrations

Pharmacokinetics of Recombinant Human Erythropoietin in Dialysis Patients after Single and Multiple Subcutaneous Administrations

Continuous Intravenous Sodium Ferric Gluconate Improves Efficacy in the Maintenance Phase of EPOrHu Administration in Hemodialysis Patients

Erythropoietin Administration for Anemia Due to Chronic Kidney Disease - Subcutaneous OR Intravenous, What Do We Know So Far?

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