Effects of dialysis factors and route of administration on response of hemodialysis patients to recombinant human erythropoietin.

Data on the use of recombinant human erythropoietin (rHuEPO) were obtained from 25 hemodialysis centers to determine whether route of administration (intravenous [i.v.] vs. subcutaneous [s.c.]) or various dialysis factors influenced the response to rHuEPO; 844 of 958 patients had sufficient data for evaluation. Hematocrit (HCT) increased from 23.8 to 29.1% after a mean rHuEPO treatment period of 202 days; 48.4% of all patients did not reach a HCT greater than or equal to 29%. The s.c. route increased HCT more than the i.v. route. Multivariate analysis of the response (i.e., increase in HCT from baseline) showed a positive correlation with more rapid dialysis but a negative correlation with reuse, baseline HCT, transfusion dependence, and frequency of administration. The effects of dialysis and reuse were not present when the response was normalized by weekly dose. It was concluded that one half of all patients treated did not attain the recommended target HCT, perhaps due to economic constraints or resetting of goals. The s.c. route may be preferable to optimize response.