An opportunity to intervene: erythropoietin for the treatment of anaemia in pre-dialysis patients

Abstract

In summary, r-HuEPO has proven effective in increasing haematocrit in predialysis patients, without hastening loss of renal function. The use of pre-dialysis r-HuEPO still needs to be studied, especially with regards to its effects on short-term and long-term cardiovascular function. However, it seems reasonable to suggest that patients with coronary artery disease, LVH, transfusion dependence, or decreased libido or potency may benefit from pre-dialysis r-HuEPO. Other candidates include patients for whom renal transplantation is the renal replacement therapy of choice, patients desiring to return to work without debilitating anaemia, school children, college students, patients with HIV and CRF and patients scheduled for elective surgery. Recommendations for r-HuEPO use in predialysis patients include control of blood pressure, close monitoring of renal function, subcutaneous administration of doses ranging between 50 and 150 U/kg weekly. The dosing should be adjusted to target a haematocrit of 33-36% and avoid any rapid rise in haematocrit (no more than a 4% in 4 weeks).