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The Efficacy of Intravenous versus Subcutaneous Recombinant Erythropoietin in Obese African-African Patients in a Southeast U.S. Dialysis Cohort

Éva Csongrádi, Michael Shoemaker-Moyle, Lajos Zsom, Catherine Wells, Zsolt Lengvárszky, Mihály Tapolyai, Tibor Fülöp

Journal of Advances in Medicine and Medical Research · pp. 184–193 · Published 14 Sep 2013

10.9734/BJMMR/2014/6244

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. 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 [<25 (n=27), 25-35 (n=38), >35 (n= 21) kg/m2]. 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/m2. 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.    

African-American body mass index end-stage renal disease obesity renal anemia recombinant erythropoietin.

References (26)

  1. 1 A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease [DOI]
  2. 2 The Effects of Normal as Compared with Low Hematocrit Values in Patients with Cardiac Disease Who Are Receiving Hemodialysis and Epoetin [DOI]
  3. 3 Anemia management and outcomes from 12 countries in the dialysis outcomes and practice patterns study (DOPPS) [DOI]
  4. 4 Meta-analysis: Erythropoiesis-Stimulating Agents in Patients With Chronic Kidney Disease [DOI]
  5. 5 The cardiovascular effects of erythropoietin [DOI]
  6. 6 2005 Annual Report: ESRD Clinical Performance Measures Project [DOI]
  7. 7 Disrupted erythropoietin signalling promotes obesity and alters hypothalamus proopiomelanocortin production [DOI]
  8. 8 The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group [DOI]
  9. 9 Subcutaneous Compared with Intravenous Epoetin in Patients Receiving Hemodialysis [DOI]
  10. 10 Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women [DOI]
  11. 11 Prevalence and Awareness of CKD Among African Americans: The Jackson Heart Study [DOI]
  12. 12 A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease [DOI]
  13. 13 Quality of life in patients with end-stage renal disease treated with hemodialysis: survival is not enough! [DOI]
  14. 14 Sleep-disordered breathing symptoms among African-Americans in the Jackson Heart Study [DOI]
  15. 15 Meta-analysis of subcutaneous versus intravenous epoetin in maintenance treatment of anemia in hemodialysis patients [DOI]
  16. 16 Effect of obesity on recombinant follicle-stimulating hormone absorption: subcutaneous versus intramuscular administration [DOI]
  17. 17 The Effects of Erythropoietin Dose Titration during High‐Fat Diet‐Induced Obesity [DOI]
  18. 18 2002 annual report: ESRD clinical performance measures project [DOI]
  19. 19 Factors Influencing Route of Administration for Epoetin Treatment Among Hemodialysis Patients in the United States [DOI]
  20. 20 A Change from Subcutaneous to Intravenous Erythropoietin Increases the Cost of Anemia Therapy [DOI]
  21. 21 Iron-Replete Hemodialysis Patients Do Not Require Higher EPO Dosages When Converting From Subcutaneous to Intravenous Administration: Results of the Italian Study on Erythropoietin Converting (ISEC) [DOI]
  22. 22 Erythropoietin-Alpha Dosage Requirements in a Provincial Hemodialysis Population: Effect of Switching from Subcutaneous to Intravenous Administration [DOI]
  23. 23 2004 Annual Report: ESRD Clinical Performance Measures Project [DOI]
  24. 24 Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease [DOI]
  25. 25 Correction of the Anemia of End-Stage Renal Disease with Recombinant Human Erythropoietin [DOI]
  26. 26 Correction of the Anemia of End-Stage Renal Disease with Recombinant Human Erythropoietin [DOI]

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Peritoneal Dialysis in Class 2-3 Obesity—A Single-Center Experience

Yougandhar V. Akula, Tibor Fülöp, Mehul P. Dixit · The American Journal of the Medical Sciences · 2017

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