Initiate Pegylated Erythropoietin treatment when the hemoglobin level is less than 10 g/dL. If the hemoglobin level approaches or exceeds 11 g/dL, reduce or interrupt the dose of Pegylated Erythropoietin.
If the hemoglobin rises rapidly (e.g, more than 1 g/dL in any 2 week period), reduce the dose of Pegylated Erythropoietin by 25% or more as needed to reduce rapid responses. And for patients who do not respond adequately, if the hemoglobin has not increased by more than 1 g /dL after 4 weeks of therapy, increase the dose by 25%
For patients who do not respond adequately over a 12 week escalation period, increasing the Pegylated Erythropoietin dose further is unlikely to improve response and may increase risks
For patients with CKD on dialysis:
- The recommended starting dose of Pegylated Erythropoietin for the treatment of anemia in adult CKD patients who are not currently treated with an ESA is 0.6 mcg/kg body weight administered as a single IV or SC injection once every two weeks.
- Once the hemoglobin has been stabilized, it may be administered once monthly using a dose that is twice that of the every two-week dose and subsequently titrated as necessary.
For patients with CKD not on dialysis:
- The recommended starting dose of Pegylated erythropoietin for the treatment of anemia in adult CKD patients who are not currently treated with an ESA is 0.6 mcg/kg body weight administered as a single IV or SC injection once every two weeks.
- Once the hemoglobin has been stabilized, it may be administered once monthly using a dose that is twice that of the every two-week dose and subsequently titrated as necessary.
- Conversion from another ESA to Pegylated erythropoietin: It can be administered once every two weeks or once monthly to patients whose hemoglobin has been stabilized by treatment with an ESA.
