Search

Synthetic erytbropoiet~ recombinant human erythropoietin (r-HuEPO), has revolutionised the treatment of anaemia caused by end stage renal failure (ESRF) by stimulating erythropoiesis. This increases red blood cell production, raising haemoglobin (Hb) and haematocrit (Hct) levels. Recipients require fewer blood transfusions and experience an improved quality of life. Studies report the subcutaneous (S/C) route of injection ofr-HuEPO is more effective than other routes such as intramuscular, intravenous and intraperitoneal. Therefore lower doses are required to maintain target Hb and Hct and treatment costs are reduced. In practice health care workers, mainly registered nurses, use any of the commonly used SIC sites. The choice of sites is based more on routine than on research evidence. Purpose: To compare the arm, thigh and abdominal subcutaneous injection sites for (A) clinical efficacy in maintaining a Hb of between 11.5-12.5 g/dl and a Hct between 34-38%, (B) cost of the dose required to maintain this target and (C) comfort convenience and side effects experienced by recipients. Method: Twenty-seven ESRF subjects completed the study. Injections were randomised to one site. Each site was crossed over and compared for a minimum of three months. Data included monthly Hb and Hct to assess efficacy, the cost of the dose required to maintain the Hb and Hct and questionnaires using a combination of self-report and visual analogue scales to assess comfort and side effects. The mean or median results of the above data were compared by analysis of variance (ANOV A). Results: There was no statistically significant difference in the efficacy or the cost between the tested sites. There was no statistically significant difference between comfort and side effects of the tested sites except for convenience. The convenience of using the preferred arm site was statistically significantly different to the other sites. This was statistically confirmed by the preference for the arm s