Why is epoetin (erythropoietin) used during dialysis?

From the Guidelines

Epoetin is administered during dialysis to treat anemia in patients with chronic kidney disease, with the goal of improving morbidity, mortality, and quality of life by stimulating red blood cell production. The medication is usually given intravenously at the end of dialysis sessions for hemodialysis patients, or subcutaneously for peritoneal dialysis patients, with doses typically ranging from 50-300 units/kg three times weekly, adjusted based on hemoglobin levels with a target of 10-11 g/dL 1. Kidney disease impairs the production of erythropoietin, a hormone naturally made by the kidneys that stimulates red blood cell production in bone marrow. Without sufficient erythropoietin, patients develop anemia, experiencing fatigue, weakness, and reduced quality of life. Epoetin serves as a replacement for this deficient hormone, effectively stimulating red blood cell production. Some key points to consider when administering epoetin include:

• The target range for hemoglobin should be 11 g/dL to 12 g/dL, as patient outcomes are worse when hemoglobin is below 10 g/dL 1
• The subcutaneous route appears to be more efficient than intravenous administration, allowing for lower weekly doses to maintain target hemoglobin levels 1
• Frequent administration, such as two to three times per week, is more efficient than once weekly administration, but daily administration is no more effective than three times per week 1
• The site of injection should be rotated with each administration, as there are insufficient data to recommend a specific site 1
• For patients who cannot tolerate subcutaneous administration, intravenous administration should be used, with a dose 50% higher than the subcutaneous dose 1

From the FDA Drug Label

In clinical studies of patients with CKD on dialysis, epoetin alfa increased hemoglobin levels and decreased the need for RBC transfusion. Overall, more than 95% of patients were RBC transfusion-independent after receiving epoetin alfa for 3 months The safety and efficacy of epoetin alfa were evaluated in 13 clinical studies involving intravenous administration to a total of 1010 patients on dialysis with anemia. Overall, more than 90% of the patients treated with epoetin alfa experienced improvement in hemoglobin concentrations In the 3 largest of these clinical studies, the median maintenance dose necessary to maintain the hemoglobin between 10 to 12 g/dL was approximately 75 Units/kg 3 times weekly. More than 95% of patients were able to avoid RBC transfusions

Epoetin is used during dialysis to increase hemoglobin levels and decrease the need for red blood cell (RBC) transfusions in patients with chronic kidney disease (CKD). The medication has been shown to be effective in improving hemoglobin concentrations and reducing the need for transfusions in over 90% of patients. The typical maintenance dose is around 75 Units/kg 3 times weekly, allowing more than 95% of patients to avoid RBC transfusions 2.

From the Research

Reasons for Using Epoetin During Dialysis

• Epoetin is used to correct anemia in patients with chronic kidney disease, particularly those on dialysis, as it has been shown to improve quality of life and clinical outcomes 3.
• The use of epoetin has led to the eradication of severe anemia in the dialysis population, and its correction has been associated with better quality of life and clinical outcomes 3.
• Epoetin treatment has been shown to improve survival and quality of life in end-stage renal disease (ESRD) patients, as well as lower overall treatment costs 4.
• Early epoetin treatment has been associated with improved survival of ESRD patients in the first year after starting dialysis and reduced costs of treatment 4.

Benefits of Epoetin Treatment

• Epoetin treatment has been shown to improve health-related quality of life (HRQOL) in anemic hemodialysis patients, with significant improvements in symptoms such as fatigue, energy, shortness of breath, and weakness 5.
• The use of epoetin has been associated with a significant increase in hemoglobin levels, with a target increase of 2.5 g/dL achievable in 90.3% of patients 6.
• Epoetin treatment has been shown to confer a survival benefit to ESRD patients, especially in those with an adequate hematocrit response before initiation of dialysis 7.

Patient Outcomes

• Patients who received epoetin treatment before dialysis had a lower risk of death after starting dialysis compared to those who did not receive epoetin 4, 7.
• Epoetin treatment has been associated with improved clinical outcomes, including reduced hospitalization rates and overall treatment costs 4.
• The use of epoetin has been shown to improve patient quality of life, with significant improvements in symptoms and functional capacity 5, 6.