Low dose erythropoietin in maintenance haemodialysis: improvement in quality of life and reduction in true cost of haemodialysis

Abstract

Human recombinant erythropoietin (r‐HuEPO) improves quality of life in patients on maintenance haemodialysis, but the haemoglobin (Hb) level necessary to achieve this improvement is unknown. In this study, quality of life, functional capacity and symptoms of 28 haemodialysis patients with an initial Hb of 67 ±2 (mean ± SEM) g/L were assessed after 0, 6 and 12 months of r‐HuEPO, the dose of which was titrated to achieve a stable Hb of between 90 and 100 g/L.At six and 12 months Hb was 97 ± 2 and 93+2 g/L, and mean r‐HuEPO dose between three and six, and between nine and 12 months was 88 ± 6 and 62 ± 9 U/kg/week intravenously respectively. There was a significant improvement in level of activity and satisfaction with various aspects of life, and a reduction in fatigue, weakness, dyspnoea, angina and restless legs. Patients were able to walk 50% further in six minutes. The improvement in quality of life and function was similar to that reported from other centres whose target Hb was between 100 and 120 g/L, and where the r‐HuEPO dose was 75% higher than in this study.Costs of r‐HuEPO therapy were assessed. The drug itself costs $A3681/yr/patient, to which was added the estimated cost of additional dialyses and medications, bringing the total to $A5177/yr/patient. There was, however, a reduction in both hospitalisation by 8.3 days/yr/patient and medical consultation by 3.9 hours/yr/patient. Five patients commenced full‐time work, one took up full‐time study aimed at finding work, three transferred to home haemodialysis and six fewer patients drew social security benefits. The net cost saving from using low dose r‐HuEPO was more than $A1,000/yr/patient.