Epo and nocturnal txs

For those on nocturnal txs, how much epo, if any, do you take?

I’d not only be interested in the answer Heather’s question, but also how often you do nocturnal hemodialysis, whether you take EPO IV or subq, whether you take it at the beginning or the end of treatment, and whether you take oral or IV iron to reach the target hemoglobin/hematocrit.

Although you didn’t ask this, here’s Medicare’s most recent policy for EPO reimbursement:

I take Epo & an Iron infusion thru the lines, start of treatment (it’s how/when we were taught to) on Fridays. They up’d my Epo script from 60 to 80. THe iron’s a standard (80?) size. I dialyse for about 9:20 M/W/F, usually starting about 21:30, by the time I’ve cannulated (which, touch wood, has now been good for over 3 weeks!). Putting the iron in is a bit of a p.i.t.a :slight_smile: , as you have 20mm of saline with it in the syringe & are supposed to manually feed it gradually in, over about 15 mins. If I use the smaller of the draw-up needles there’s quite a bit of pressure; if I use the larger one, the beast tends to suck it in faster than I want ! :roll:
(I also do a 6:00 run on SUnday evenings)

Glad to hear those buttonholes are behaving Bear!

I havn’t needed iron for over 2 months now and usually do Epo once a fortnight either through lines similar to Bear or sometimes if i can’t be bothered stuffing around just under skin around belly.
Iron 100mg then fill 20ml syringe up to 10 ml with saline delivered over an hour same way as Clexane at start of Nocturnal after Clex bolus given.

I am on NxStage and we are not allowed to give Iron or Epo thru the machine. I have to get my epo subQ twice a week and I am not getting Iv iron. Not that they wouldn’t love to give me IV iron. My veins just can’t take it and neither can I. I have a really low Hemoglobin and My crit is low too.

I’m lucky I don’t have any adverse reactions or problems with iron - I need it!! :smiley: My hg was 101 on the bloods done this week. It has been up to 110.
I’m feeling rather good lately, physically and mentally. 8)

Can’t you get IV iron at your dialysis clinic on a periodic basis using your hemodialysis access? Most dialysis patients need to take iron by IV because the GI tract doesn’t absorb oral iron that well an because patients can can have stomach problems and diarrhea from some oral iron products. Of course, this depends on the iron product and your body. If you’re not getting IV iron and you’re not taking oral iron, it’s likely that your iron stores in your body are very low. If you don’t have enough iron stores in your body, any EPO you get won’t work very well.

You might ask your doctor or nurse if you should be taking oral iron if you can’t tolerate IV iron. Taking oral iron may help relieve the symptoms of anemia. Some symptoms of anemia include fatigue, shortness of breath, poor appetite, problems thinking, and even sexual problems. Correcting anemia is not only good for improving your quality of life, but it can help you live longer too because having anemia long-term causes damage to the heart.

my hemo access is a quiton catheter. My veins collapse when I get Iron. while I was training they would give me iron thru the machine. The nurse was supossed to give it to me in intervals. A couple of times she would space it and have to double up on it. This would cause immense pain in my catheter. I take Proferrin Forte for oral iron. Because of my GI problems I can not use ferrous solfate(SP?). I try to eat red meat and other things that are high in iron. I am very anemic and very well could someday die from complicaations from it.

THis seems a bit odd - she’s putting it in thru the machine, but not automatically??? We only put ours in manually up front, at home, so we don’t have to think about it at the end, so we can still sleep thru that last hour - but that’s when they used to put it in in-center: when the heparin was stopped an hour before the end & they would swap syringes to the iron&saline one & it would drip-feed in, same as heparin does.

Not odd at all actually. The nxstage machine has a short line with a blue clamp at the top of the dialyzer. She would put a syringe on that connection and administer it at intervals. When I was incenter they would do the same thing basicly. Attach a syringe after the filter and inject into the line. They are supposed to be using this new kind of iron here. They say it does not iritate the veins. Well maybe not on everyone else, but on me it does. When I have gotten it IV it blew the vein and left a purple mark on my arm for two weeks. Never mind how much it burned before the vein blew. It burns my veins when they put it in the quinton too. It has to be given slowly over three or more hours before it is acceptable. You have to remember I do not use a fistula. Though I would suspect that I would have simular problems with a fistula.

one thing has to be observed here, each and every person is different. Just because something works one way for one person does not mean it will for another. I have been to many different clinics and I have seen many nurses do different things. A lot of the technigues are standardized these days, but not always for every patient.

I have also heard of liquid, orally taken iron that some patients say is gentle on the system and very effective.

Hi All,
Just got a chance to reply to this. I do EPO Sub Q current rate is 7.5 2 times a week and Iron 1 bottle 2 times a month for Hubby Ralph

Previously had read posts of home patients who said they either had no further need for epo or only required very low dose. Not sure if this applies to SDD or SND. So, wondered according to how many hrs/days of dialysis per week one is doing how much epo dose has changed from 3x in-center? And in-center it is given each tx, so is it the same way at home or less often?

I am not an authority on this but I believe each person is different.
My hubby went from 6000 3 X a week down to 7500 2 times a week because his HGA went up. The last time bloods were drawn it was down again. We need to wait till next blood work is done to see if it down again or even more. If he becomes real tired I need to let them know.
I remember back in Sept of 2004 after he had bi pass surgery his blood was so low that he was taking 30,000 three times a week. So as you can see it really depends on what the circumstances are.
We draw blood twice a month to keep tabs on this as well as other things.

I get 15,000 twice a week subq. I was also told that I may not need so much epo on home hemo. The thing is, my peritoneal membrane is probably still bleeding sometimes even without an access to it. they tapped me once and pulled this black pudding like stuff and they went deep into my belly with the needle. They seemed pretty freaked by it, but they never really told me what it was. I know what it was though. It was collaguated blood from my peritoneal. So I still need lots of EPO and I take oral proferrin forte. Proferrin Forte is a very large dose of folic acid and some iron. The Folic acid aids in the digestion of Iron. I don’t have any adverse effects from it, but I am still anemic. It is also very new and rare to see being used. We had to find the manufactures number and got hold of their rep to get it in our pharmacy.

Con does nocturnal every second night / 8 hours a night.
he has EPO every 3weeks. 10,000 iu. We inject it into the venous line a few minutes before the end of dialysis.
He hasn’t had any iron for well over 6 months now. But, when he did have iron he was having 2mg with 8 mls of saline in a 20 ml syringe. This was attached to the heparin pump in the last hour of dialysis. We turned the heparin off 1hour 30 minutes before the end of dialysis.

His hemoglobin is 140-142 always.

cheers Queenie.

Quenie wrote:

he has EPO every 3weeks. 10,000 iu. We inject it into the venous line a few minutes before the end of dialysis.
He hasn’t had any iron for well over 6 months now. But, when he did have iron he was having 2mg with 8 mls of saline in a 20 ml syringe. This was attached to the heparin pump in the last hour of dialysis. We turned the heparin off 1hour 30 minutes before the end of dialysis.

Is there a reason why epo is given a few minutes before the end of tx and why iron is given in the last hr? We are wondering if there is a best time to give these meds.

Sorry, I forgot to say that Venefer is injected into the IV line while I give Ralph’s EPO sub Q.
Sorry I don’t get to post much, although I read all posts everyday.
This is such a great message board.


This came out last Friday regarding EPO. It says essentially that home patients have been exempted from the regulations about monitoring EPO dose and decreasing payments as describe in the post from Beth on Sunday.

I. SUMMARY OF CHANGES: Change Request 4135 titled, National Monitoring Policy for EPO and Aranesp for End Stage Renal Disease (ESRD) Patients Treated In Renal Dialysis Facilities, instructed the Medicare system to not apply a 25% payment reduction on claims for EPO or Aranesp when a GS modifier was reported on the claim. The GS modifier was defined as “Dosage of EPO or Darbepoetin Alfa has been reduced 25% of preceding monthýs dosage.” The definition of the GS modifier has been revised since the implementation of CR 4135. In addition, change request 4135 announced that the policy did not apply to patients who elect to receive their dialysis at home; however, change request 4135 did not instruct system maintainers to exempt claims for patients who elect to receive their dialysis at home.

This CR notifies contractors and providers that the the GS modifier definition is revised and instructs system maintainers to exempt claims from patients that receive their dialysis at home.

The full text is at http://www.cms.hhs.gov/transmittals/downloads/R1043CP.pdf

Jim Curtis

Thanks for posting this Jim. I just read the new policy yesterday and was thrilled to see that it doesn’t apply to home dialysis patients.