Valentini RP, Sedman AB, Smoyer WE, Kershaw D, Gregory M,
Bunchman TE
The safety and efficacy of intraperitoneal erythropoietin in
children on CCPD
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Nov) 6:514 1995
Intraperitoneal EPO has been impractical in CAPD patients due
to the extremely high doses and hence expense associated with
this route. A "dry" daytime peritoneum, however, appears to
improve bioavailability. The authors of this study followed 5
children (13.8+/-1.6 yo) for a mean 17 weeks. All were treated
with a 4 hour "dry" IP EPO dwell and followed by one daytime 6
hour dwell before finally draining in preparation for CCPD. 4
children received 300 U/kg IP once a week and one received
615 U/kg IP in divided doses twice a week. In the end, the mean dose of
IP EPO on a weekly basis was 310 U/kg vs. former dosing SC of
262 U/kg/wk. No increase in peritonitis was detected. Most
notable was an unexplained rise in PTH levels from 537 to 758
detected while children were on IP EPO. While cost and
complication issues continue to be of concern, the authors
suggest a subset of non-compliant or injection-shy patients may
be served by the alternative IP route.
Additional comments by Steven Fishbane: This small study looked at IP
dosing of EPO in children on CCPD. Other
studies of IP dosing have shown poor EPO bioavailability with CAPD; in CCPD
the long daytime dwell could allow for increased EPO absorption. EPO was
administered during a 10 hour (first 4 hours dry) daytime period. The
primary
findings were stable or improving hematocrits on IP EPO. Doses of EPO rose
by
18% with IP dosing, but the increase was not statistically significant.
Comment: IP dosing of EPO would have the obvious advantage of avoiding
sub-q
injections. This study is provocative, but is too small to reach meaningful
conclusions. If EPO doses remain relatively stable with IP dosing in CCPD,
and if the peritonitis incidence does not increase, then this would be a
valuable tool.
(Narsipur)
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Am Soc Nephrol
CRF by problem area :
Anemia/Erythropoietin/Iron
CRF by problem area :
CRF in infants and children