Can epoetin alfa (Retacrit) be administered before dialysis?

Can Retacrit (Epoetin Alfa) Be Given Before Dialysis?

Yes, epoetin alfa (Retacrit) can be administered before dialysis, but the optimal timing is during or after the dialysis session when using the intravenous route, with injection into the arterial or venous blood lines at any time during the hemodialysis procedure. 1, 2

Timing of IV Administration During Dialysis

• When using IV administration, inject epoetin alfa into either the arterial or venous blood lines (the "ports") at any time during the hemodialysis procedure. 1, 2, 3
• The medication can be given at the beginning, middle, or end of the dialysis session without compromising efficacy. 1
• Avoid injecting into the venous drip chamber of the Fresenius delivery system, as this can result in "trapping" and incomplete mixing with the patient's blood. 1, 2, 4

Dosing Frequency for IV Administration

• The weekly IV dose should be divided and given during each dialysis treatment (typically three times per week). 1, 2, 3
• Once-weekly IV administration results in a lower hemoglobin response and requires approximately 25% higher epoetin doses compared to three-times-weekly administration. 1, 3
• The National Kidney Foundation guidelines recommend 120-180 units/kg/week divided into three doses for hemodialysis patients receiving IV epoetin. 2

Subcutaneous Administration as an Alternative

• Subcutaneous (SC) administration is 15-50% more efficient than IV administration, requiring lower doses to maintain target hemoglobin levels. 2, 4, 3
• When patients begin dialysis treatments, continuing SC administration (rather than switching to IV) is recommended. 1
• The SC route allows for administration before, during, or after dialysis, or even on non-dialysis days, providing greater flexibility. 1
• If converting from IV to SC, use approximately two-thirds of the IV weekly dose when target hemoglobin has been achieved. 4, 3

Monitoring Requirements

• Measure hemoglobin/hematocrit every 1-2 weeks following initiation or dose adjustments. 2, 3
• With optimal iron stores, expect a hemoglobin rise of approximately 0.3 g/dL per week (range 0.2-0.5 g/dL). 1, 2
• Ensure adequate iron stores before and during treatment (transferrin saturation >20%, serum ferritin >100 μg/L), as iron deficiency is the most common cause of inadequate response. 2, 3

Common Pitfalls to Avoid

• Never inject into the venous drip chamber, which causes incomplete drug delivery. 1, 2, 4
• Do not give the entire weekly IV dose as a single injection, as this reduces efficacy by 25%. 1, 3
• If using IV administration for a patient who cannot tolerate SC injections, increase the dose by approximately 50% compared to the SC equivalent. 1, 2
• Be aware that 96% of patients respond within 4-6 months at appropriate doses with adequate iron stores. 2, 3