When to Give Epogen and Hectorol?

NurseRies, BSN, RN · Feb 8, 2014

I was always under the impression that they could be given anytime, even in acutes.. There is prob either no real data on this topic or it is doctors preference. These drugs should not dialyze out. Research shows epogen is best given SC instead of IV, also something to consider.

Chisca, RN · Feb 8, 2014

Neither is removed by dialysis but I can see how epogen might be timed towards the end of a treatment due to hypertension. If someone's BP is already high the epogen could cause it to get worse if you gave it earlier.

westieluv · Feb 8, 2014

Thanks for both of your replies. Apparently, I was told the wrong information by my preceptor in acutes, because he said to always give the Epogen during the last 10 minutes of the tx. That may be realistic in acutes, but in chronics when everyone is coming off at about the same time? Forget it!

Are there chronic units that give Epogen subcutaneously? That's not even an option at our clinic, as far as I know.

NurseRies, BSN, RN · Feb 8, 2014

Thanks for both of your replies. Apparently I was told the wrong information by my preceptor in acutes, because he said to always give the Epogen during the last 10 minutes of the tx. That may be realistic in acutes, but in chronics when everyone is coming off at about the same time? Forget it! Are there chronic units that give Epogen subcutaneously? That's not even an option at our clinic, as far as I know.[/quote']
A lot of clinics have converted to SC epo. It is proven in numerous studies as more effective and you can use 25-40% less of the drug. So someone who gets 10,000 IV 3X a week, may only require a once weekly 15,000 SC shot, with same results. This is doctor preference usually. If your doctor isn't using it, you could ask him why he chooses IV over SC? Maybe he has reasons. Not always the case, but in many cases, epo is a money maker- the more you use, the more the clinic gets paid. Again, it always comes back to money.
But id ask the MD and see what his reasoning is. I was the anemia manager in my old clinic. We switched to SC shots and I decreased everyone's dose by 25% and we achieved the same results. Target hemoglobins were reached. Just keep it mind, it would take 4-6 weeks for you to see results of epo. So an increase or decrease in dose won't immediately take effect. Our doctor took a chance on SC and we had great results. Some patients even had a once a month shot. Epo is a heavy duty drug, so it is in the patients best interest to use less, especially if hypertensive. Also keep in mind all the many, many things that cause hemoglobins to drop- usually inflammation. All our patients have some degree of inflammation, but there's some people that you just won't be able to get perfect labs on.

westieluv · Feb 8, 2014

The more Epo you use the more the clinic gets paid? Really? That's pretty tacky! I know we give a lot, normally 3 doses a week for each of our chronic patients, and we have to treat it like liquid gold, literally sucking the last drop out of each vial. That's the only reason that I can think of why we aren't giving it SC, although I know that some of our patients would complain vehemently if they had to get even a tiny SC shot once a week, since most of them never really have to think about the $$$$ end of things.

DialysisRN34, BSN · Feb 11, 2014

The 2008 bundle convert Epogen payment into one lump sum amount a tx. The unit gets paid for a flat Epogen amount on every patient every tx (I think it is 3600 units q tx). So, the opposite is true. The less Epogen we use the more money the unit makes. CMS did that due to concerns that units were overdosing to make money.

DialysisRN12 · Feb 16, 2014

And c'mon all...very few patients are going to let you stick them on a weekly basis even tho it is SC. Try making that switch in a clinic with patients who've been there for years. Efficacy doesn't really apply to the dialysis patient since the reason most of them are there in the first place is due to lack of responsible health care maintenance and non compliance.

Sent from my iPhone using allnurses.com

NurseRies, BSN, RN · Feb 17, 2014

And c'mon all...very few patients are going to let you stick them on a weekly basis even tho it is SC. Try making that switch in a clinic with patients who've been there for years. Efficacy doesn't really apply to the dialysis patient since the reason most of them are there in the first place is due to lack of responsible health care maintenance and non compliance. Sent from my iPhone using allnurses.com

I dunno about that. I was part of the transition at a clinic and we started to educate all of them over the course of a month. Some people were grumbling about the shot but they understood that it was better for them and they could be given lower doses. We only had one patient out of 60 that completely refused.

And although many of them still don't do a great job with their health management, many of them truly care about feeling the best they can. I can only think of a few patients that it really was their own fault. Many people are older, years of poorly controlled hypertension or diabetes can be simply lack of education, lack of understanding, or environment and life circumstances. Lots of patients take very good care of themselves with the help of their families and regular supervision with a doctor. So, I do not agree at all that we can clump dialysis patients into one large group where all patients act the same and don't care. That's not fair at all. If we believe that they don't care about themselves and there's no point to try, then we are doing a meaningless job. The people that truly don't care, don't live long. The ones that have been there for years are often the ones that care the most and follow doctors /nurses advice, take their meds, etc. Sure, they don't like changes, but they will get over it.

DialysisRN12 · Feb 17, 2014

You said it in your post "htn, years of poorly controlled diabetes." That's my point. I care about my patients and I know that they want to live. But at the same time it's lack of responsibility to participate in their own health care or being accountable. HTN is preventable, manageable. Diabetes is preventable, manageable. Of course, there are always going to be those outliers. I'm not talking about those patients that lost kidney function due to other reasons beyond their control. But those two reasons make up the large majority of patients on dialysis.

Sent from my iPhone using allnurses.com