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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Erythropoietin: maintenance therapy Erythropoietin: maintenance therapy

  • Hb level should be monitored monthly in HD patients and 2 monthly in predialysis or PD patients.
  • If Hb remains at target level, drug dose can be kept unchanged, although dose frequency can be reduced if SC route is being used (keeping total dose unchanged). Some patients can be maintained on 2-weekly EPO, or monthly darbepoietin.
  • Iron status is crucial to maintaining adequate Hb levels. Ferritin and transferrin saturation status should be checked monthly in HD patients and 2 monthly in predialysis and PD patients. Regular intravenous iron is needed by many patients.
  • Maintenance dose is often 75% of the final dose used during the initial phases of treatment.
  • Increased doses may be required during intercurrent illnesses to maintain Hb, but there are no data on the best management strategy. Post-transplantation it may take a month for the graft to resume secretion of EPO.
  • If given intravenously, EPO should be infused towards the end of dialysis. AN69 in particular can adsorb large amounts of EPO.

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