Recombinant Human Erythropoietin Therapy in Haemodialysis Patients—Dose Determination and Clinical Experience

Recombinant human erythropoietin (R-Hu-EPO) was given to stable, long-term haemodialysis patients with haematocrit≤25% who required no blood transfusions. Thirteen patients were initially given R-Hu-EPO at 24 U/kg i.v. at the end of each dialysis session, with a doubling of the dose every second week until a dose of 96 U/kg (n=6) or 192 U/kg (n=7) was reached after 8 weeks. In addition, three patients were given 24 U/kg for 2 weeks and subsequently 48 U/kg for 14 weeks. Median haematocrit increased from 19.4% (14.8–24.3) to 30.0% and 32.5% with 96 or 192 U/kg respectively. Starting 7 days after R-Hu-EPO a log dose-dependent increase in reticulocyte counts was noted. A consistent decrease in ferritin concentrations was observed despite oral supplementation of iron. A continuous rise in platelet counts was noted. Irrespective of blood-pressure status, predialysis blood pressure increased in six of nine patients who were not on anti-hypertensive medication; increased antihypertensive therapy was required in the others. A rise in bilirubin within the normal range was seen at the end of the study. No severe clinical side-effects occurred; specifically, there were no thrombotic episodes with the exception of clotting of two fistulae with known stenosis. There was no evidence of decreased efficacy of dialysis, as indicated by unchanged predialysis plasma creatinine, potassium and phosphate. Pre-existent Raynaud's phenomenon markedly improved in three and disappeared in three of seven patients. The patients reported increased well-being, and of six male patients, three reported increased libido, two of whom also increased potency.