Giving EPO injection

[ChickenLittle56]

Today the nurse was doing her round of giving medications. She came to and proceeded to giving the EPO in the arm when I stopped her. I told her that they usually put it through the line. She told me that the Neph. said that everyone gets it in the arm. I told to forget todays EPO and I will talk with the Neph. on Monday when he does his rounds. I have always had it in the line since I started. I want to know why is it being done now. The less needle pokes that I recieve the less stress in my life. I am in a Fresenius clinic and I wonder if this is the new company wide policy they started or is it just this Neph.

[greg10]

Today the nurse was doing her round of giving medications. She came to and proceeded to giving the EPO in the arm when I stopped her. I told her that they usually put it through the line. She told me that the Neph. said that everyone gets it in the arm. I told to forget todays EPO and I will talk with the Neph. on Monday when he does his rounds. I have always had it in the line since I started. I want to know why is it being done now. The less needle pokes that I recieve the less stress in my life. I am in a Fresenius clinic and I wonder if this is the new company wide policy they started or is it just this Neph.

EPO is more effective and lasts longer in the body if injected into the adipose tissue and not through the dialysis cartridge into the blood stream.  The recent changes to bundling of Medicare payments for drugs such as EPO may have something to do with the changes in modes of injections.  Previously EPO was paid separately by Medicare and dialysis centers had a monetary incentive to give as many injections as possible and their method was just to introduce them into the dialysis port without too much patient attention and notification. 
  This may be a blessing in disguise because erythropoietin is associated with an increased risk of adverse cardiovascular complications in patients with kidney disease if it is used to increase hemoglobin levels above 13.0 g/dl.

Correction, make that 12.0 g/dl:
"However, correction of anemia to hemoglobin levels greater than 12 g/dL (to convert to g/L, multiply by 10) appears to increase the risk of adverse cardiac outcomes and progression of kidney disease in some patients."
http://www.mayoclinicproceedings.com/content/82/11/1371.full

[okarol]

I heard this: Clinics that gave EPO in the lines were giving twice as much and charging large fees. Now with bundling they will give injections which cost less and actually work better.

[Riki]

why are they using EPO? I haven't been on that since I was 14 or 15.. we use Aranesp.  We only need it once ever 2 weeks and it's given through the line.  I only know of one person in my unit who uses EPO, and that's because he had a bad reaction to Arenesp once.

[greg10]

why are they using EPO? I haven't been on that since I was 14 or 15.. we use Aranesp.  We only need it once ever 2 weeks and it's given through the line.  I only know of one person in my unit who uses EPO, and that's because he had a bad reaction to Arenesp once.

I am guessing you are not in the US.  Amgen has made over $25 billion on EPO and still has the monopoly in the US on this type of drug (they have managed to beat back Roche and others in patent claims in the US until perhaps 2014).  They kicked back some handsome profits to the clinics and nephrologists in the US and that makes 25 billion reasons why they are still using EPO.

[RichardMEL]

Aranesp and epo are really very similar anyway. I guess it depends on what the particular neph likes to perscribe. In my unit they have patients on both - so the loicked fridge has everyone's scripts in there with like epo AND aranesp. I'm on the big A and it's done through the line - I think here epo is also done through the line. Confusing huh?! lol

btw Amgen makes Aranesp too, so they win either way....

[Riki]

I certainly prefer Aranesp over Epo.  When I was on PD, I got the injections, so it was much better to have one injection every 2 weeks, then to have 3 injections per week.  Definitely kept my arms from getting sore. *G*

[okarol]

Jenna did her own injections in her thigh. The first time we got Epogen they charged us cash $220!! for a tiny bottle. By the time I got home it had broken even though it was in a pill bottle and in an ice chest. I nearly screamed when I saw it. I had to get right back in the car and go all the way back to the pharmacy at Children's hospital and the pharmacist argued that I must have used some, then broke the bottle. I almost leaped over the counter but I think he saw the rage in my eyes and decided to replace the bottle at no charge. Sheesh!

[ChickenLittle56]

There is only one reason why I prefer to have injected into the line and that is because I HATE NEEDLES(mmmm...maybe there should be a www.ihateneedles,com website) Others on this site have said the same thing about needles. I have my blood work that other doctors order on lab days. Anything that would avoid that extra stick. If its given once a week then maybe.

[Riki]

ask about the Arenesp.. once every 2 weeks is so simple, even if they do have to stick you

[needlephobic]

Be a cold day in hell when the give me a injection I can't stand needles that would make me not to want to do treatment if they start that

[Bruno]

I was on Aranesp needles...but they were easy to use...you press a little button and feel a slight sting but the needle is hidden. Then when I went on dialysis they put it into the line. The frequency can vary according to your blood test, currently I'm weekly but I have been fortnightly. In the line is better because they usually do an iron infusion at the same time. Apparently this makes the Aranesp more effective. Certainly does in my case.
I don't know about EPO...my nurse just said it's something they used to use.

[Riki]

Epo is something they used to use here too, I mean, I was on it last when I was 15.  That was 15 years ago. *G*

[fiOS-Dave]

Aranesp is used to help generate red blood cells, since kidney damage slows the generation of natural erythropoetin.
If Aransep is not given, anemia will increase. When this happens, transfusions become necessary and this is far more dangerous than Aranesp, when given properly and within safe limits. Iron infusions are given because the newly emerging red blood cells need the iron most at that point in time.
I specifically requested a Fresenius clinic since I discovered that other companies , like DaVita,lobby against transplantation in order to increase their profits. Since I am on two transplant lists, I want every possible advantage I can get which helps cut down the waiting time.
 

[calypso]

Rofflecopter

I did the exact opposite that you did when I started HD. They gave me aranesp thru the machine's lines and I asked if I could get the shot instead. I did this for 2 reasons: I was giving myself the shot for 6 years of PD and was used to it. Also because I knew it was more effective that way ( you need a lower dose if you do it subcutaneous rather than IV)

They said no. They want to charge the insurance more lols. <---they didnt say that, just no lol ...  but I know that's why.

[ChickenLittle56]

Well I talked to the neph today and he gave me all kinds of excuses from its better for me to the nurses were supposed to be giving the injection instead. They were supposed to stop giving it through the iv long ago. I told him that I am terrified of needles but that I am willing to try the needle for a week and if still bothered me by next Monday that I will be back on IV. So I had it done today and I was still pretty nervous about it. I am just worried about one day I get stuck in a bad way. 

[calypso]

The small needle subcutaneously delivered bothers you but 15 gauge needles into your fistula (directly into your bloodstream) do not?

[ChickenLittle56]

Its funny how that works that I can have those huge needles going into my arm yet I can't stand the small needles. I get more nervous and freaked out when I go give blood at the doctor;s office for tests that I would beg that the D clinic to do it at lab time. This goes for flu, pneumonia and others also. If it can be put into the line then I say do it otherwise I will put up a stink. 

[chook]

I was on Aranesp a couple of years ago and handled it okay except thought it was very painful. I went off it and some 12 months after, was put back on Neorecorman, which is EPO too but self injected. I actually prefer to do it this way than with the 'pen' - less pain. Mind you, it is only once a fortnight. I started off by having a nurse (relative) inject me but after the second time, decided I was just being stupid and once I'd done it once, all good. I use it to counteract anemia

[ChickenLittle56]

I slowly beginning to tolerate the Epo injection because its the same nurse that gives it to me. I am not sure how I would react to a different nurse giving it. Before I started D I would go to the neph's office for the Epo injection and she nurse would jammed that needle very hard every time. I know there are very good nurses that try to make it comfortable as possible and some that have an evil streak.

[Des]

Today the nurse was doing her round of giving medications. She came to and proceeded to giving the EPO in the arm when I stopped her. I told her that they usually put it through the line. She told me that the Neph. said that everyone gets it in the arm. I told to forget todays EPO and I will talk with the Neph. on Monday when he does his rounds. I have always had it in the line since I started. I want to know why is it being done now. The less needle pokes that I recieve the less stress in my life. I am in a Fresenius clinic and I wonder if this is the new company wide policy they started or is it just this Neph.

EPO is more effective and lasts longer in the body if injected into the adipose tissue and not through the dialysis cartridge into the blood stream.  The recent changes to bundling of Medicare payments for drugs such as EPO may have something to do with the changes in modes of injections.  Previously EPO was paid separately by Medicare and dialysis centers had a monetary incentive to give as many injections as possible and their method was just to introduce them into the dialysis port without too much patient attention and notification. 
  This may be a blessing in disguise because erythropoietin is associated with an increased risk of adverse cardiovascular complications in patients with kidney disease if it is used to increase hemoglobin levels above 13.0 g/dl.

Correction, make that 12.0 g/dl:
"However, correction of anemia to hemoglobin levels greater than 12 g/dL (to convert to g/L, multiply by 10) appears to increase the risk of adverse cardiac outcomes and progression of kidney disease in some patients."
http://www.mayoclinicproceedings.com/content/82/11/1371.full

Well I have a problem with this as the normal on my lab is actually 13. So that is what mine is. Does this mean that I am getting too much EPO?

[cariad]

Well I have a problem with this as the normal on my lab is actually 13. So that is what mine is. Does this mean that I am getting too much EPO?

Oh, Des.... If the measurements are the same as the US, then if you are receiving *any* EPO, it is too much. How often is your HGB monitored? In the US, insurance will not cover EPO shots until your HGB falls below 11, which amazingly is a policy with which I agree because this is a clear safety issue. If your HGB is above 11 when you come into dialysis and they are still giving you EPO, you must talk to your doctor about this. Renal patients have died from this - please be careful. I hate to scare you, but would rather scare you than see you get hurt. The difficulty for renal patients is that they do not produce their own EPO, so rather than having the kidneys release small amounts of hormone every day, you get your injection, your hormone level skyrockets, and then falls until your next injection. Not an ideal solution, but better than nothing. You need to get your blood checked before your EPO shot to get an idea of where your levels are when it's been a few weeks since your last injection. Is your 13 level from a blood draw right after the EPO is administered, or before? If they are taking your level after dialysis, dehydration can give levels that are deceptively high when it may just be that you are a bit dehydrated. I would contact your doctor at the next opportunity.

Good luck, Des.

[Bruno]

"The small needle subcutaneously delivered bothers you but 15 gauge needles into your fistula (directly into your bloodstream) do not?"

Calypso...they inject the needle into the line...it's absolutely painless.

There's no doubt it's also more effective if injected into the skin, but I think they use the line where I am because it's usually preceded by an iron infusion which enhances the aranesp take up.

[ChickenLittle56]

Cariad, I got my labs for the past 4 months and I was wondering which one is HGB. Is that hemoglobin, if it is then it is at 12.9. My value was as low as 10.4 to as high as 11.7 before I started injection of EPO in the skin. I am going to talk to the neph next Monday and ask him about it..

[ChickenLittle56]

This is what I found on the Wikipedia about Hgb, its about same info that I found on other med sites. Maybe someone can clarify the information, if its the same values as when you have kidney failure.

from http://en.wikipedia.org/wiki/Hemoglobin

Hemoglobin concentration measurement is among the most commonly performed blood tests, usually as part of a complete blood count. For example it is typically tested before or after blood donation. Results are reported in g/L, g/dL or mol/L. 1 g/dL equals about 0.6206  mmol/L.[50] Normal levels are:
Men: 13.8 to 18.2 g/dL (138 to 182 g/L, or 8.56 to 11.3 mmol/L)
Women: 12.1 to 15.1 g/dL (121 to 151 g/L, or 7.51 to 9.37 mmol/L)
Children: 11 to 16 g/dL (111 to 160 g/L, or 6.83 to 9.93 mmol/L)
Pregnant women: 11 to 12 g/dL (110 to 120 g/L, or 6.83 to 7.45 mmol/L) [51][52]

Normal values of hemoglobin in the 1st and 3rd trimesters of pregnant women must be at least 11 g/dL and at least 10.5 g/dL during the 2nd trimester.[53]

If the concentration is below normal, this is called anemia. Anemias are classified by the size of red blood cells, the cells that contain hemoglobin in vertebrates. The anemia is called "microcytic" if red cells are small, "macrocytic" if they are large, and "normocytic" otherwise.

Hematocrit, the proportion of blood volume occupied by red blood cells, is typically about three times the hemoglobin level. For example, if the hemoglobin is measured at 17, that compares with a hematocrit of 51.[54]