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If dose adjustment is required to maintain the target Hb level above 11 g/dL, the monthly dose should be adjusted by ~25%. If the rate of rise is >2g/dL over 1 month or if the Hb level is increasing and approaching 12 g/dL, the dose is to be reduced by ~25%. If the Hb level continues to increase, therapy should be interrupted until the Hb level begins to decrease, at which point therapy should be restarted at a dose ~25% below the previously administered dose. After dose interruption a Hb decrease of ~0.35 g/dL per week is expected.¹ Dose adjustments should not be made more frequently than once a month.¹

 

References:

 

1. Sulowicz W, Locatelli F, Ryckelynck J-P, et al. Once-monthly subcutaneous continuous erythropoietin receptor activator (C.E.R.A.) maintains stable control in patients with chronic kidney disease on dialysis directly converted from epoetin one to three times weekly. Clin J Amer Soc Nephrol. 2007 doi:10.2215/CJN.03631006.