From the FDA Drug Label
For correction of anemia in hemodialysis patients, a greater biologic response is not observed at doses exceeding 300 Units/kg 3 times weekly.
The maximum dose of procrit in a patient with dialysis and Hb 7 is 300 Units/kg 3 times weekly 1.
- Key points:
- The dose of procrit should not exceed 300 Units/kg 3 times weekly.
- The rate of hemoglobin increase varies among patients and is dependent upon the dose of procrit administered.
- Important consideration: The dose should be titrated to achieve the desired hemoglobin level, and the patient should be monitored for adverse effects.
From the Research
For a dialysis patient with a hemoglobin (Hb) level of 7 g/dL, the maximum recommended dose of Procrit (epoetin alfa) should not exceed 300 units/kg three times weekly, with the goal of gradually increasing hemoglobin to 10-11 g/dL, as suggested by the most recent and highest quality study 2.
Key Considerations
- The dose of Procrit should be initiated at 50-100 units/kg three times weekly and adjusted based on hemoglobin response.
- Iron status should be evaluated and supplemented if needed, as iron deficiency can limit erythropoietin response, as noted in a study on iron deficiency in patients with dialysis-associated anemia 3.
- Hemoglobin should be monitored weekly until stable, then at least monthly, to avoid rapid increases (>1 g/dL in any 2-week period) due to cardiovascular risks.
- Treatment aims to reduce transfusion requirements while avoiding excessive hemoglobin levels above 11-12 g/dL, which have been associated with increased cardiovascular events in chronic kidney disease patients, as highlighted in a study on the optimal hemoglobin in dialysis patients 4.
Administration and Monitoring
- Procrit administration can be intravenous (preferred in hemodialysis) or subcutaneous (for peritoneal dialysis or pre-dialysis patients).
- The risk of transfusion is significantly associated with facility-level hemoglobin concentration, as shown in a study on the effect of facility-level hemoglobin concentration on dialysis patient risk of transfusion 5.
- A study on the effect of epoetin alfa on exercise tolerance and physical function in dialysis patients found that treatment with epoetin alfa improved exercise tolerance and physical function, as measured by the Treadmill Stress Test and 6-Minute Walk Test 6.