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Erythropoietin: Subcutaneous administration

Wajeh Y Qunibi, MD
William L Henrich, MD, MACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


Although erythropoietin (EPO) is commonly given intravenously to patients on maintenance hemodialysis, there are a number of advantages of subcutaneous administration in hemodialysis, peritoneal dialysis, and predialysis patients. These include longer half-life; more sustained plasma erythropoietin concentration, which contributes to the requirement for a lower dose; and possibly a lower risk of erythropoietin-induced hypertension. Of practical consideration, subcutaneous erythropoietin offers chronic kidney disease (CKD) patients who are not on hemodialysis the option to self-administer the drug without the need for a clinic visit (unless required for insurance reasons) and intravenous access. However, the adverse effects of subcutaneous erythropoietin are generally similar to those for intravenous erythropoietin.

Some patients complain of pain at the site of injection, possibly induced by the citrate used as a stabilizer; this may be minimized by using a concentrated formulation.

The development of pure red cell aplasia has principally been associated with the subcutaneous administration of a specific erythropoietin product (Eprex) that was manufactured and marketed outside the United States. This disorder has also been reported less frequently with other preparations. Based upon some analysis, the manufacturer instituted a "best handling practice" program, which coincided with a change in labeling in which subcutaneous administration of Eprex is contraindicated in patients with CKD. Erythropoietin-related pure red cell aplasia is now extremely rare. (See "Pure red cell aplasia due to anti-erythropoietin antibodies".)

The following is a brief overview of the use of subcutaneous erythropoietin among patients with CKD. A detailed discussion of the use of this agent in this patient population is presented separately. (See "Erythropoietin for the anemia of chronic kidney disease among predialysis and peritoneal dialysis patients" and "Erythropoietin for treatment of the anemia of chronic kidney disease in hemodialysis patients".)

Adverse effects of erythropoietin-stimulating agents (ESA), including erythropoietin, are discussed elsewhere. (See "Anemia of chronic kidney disease: Target hemoglobin/hematocrit for patients treated with erythropoietic agents", section on 'Adverse effects' and "Erythropoietin for treatment of the anemia of chronic kidney disease in hemodialysis patients", section on 'Adverse cardiovascular effects with high hemoglobin levels' and "Erythropoietin for the anemia of chronic kidney disease among predialysis and peritoneal dialysis patients", section on 'Adverse effects'.)


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Literature review current through: Sep 2016. | This topic last updated: Jun 24, 2015.
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