Attitude of Physicians toward the Use of Erythropoietin in Hemodialysis Patients

We attempted in this study to evaluate the attitude of the physicians in The Kingdom of Saudi Arabia (KSA) towards the use of recombinant human erythropoietin (r-HuEPO) in patients on hemodialysis (HD). We sent a questionnaire to 181 physicians in the 147 active dialysis centers in KSA; 110 (74.9 %) of them were under the Ministry of Health (MOH), 14 (9.5%) in Governmental non-MOH hospitals and 23 (15.6 %) were in private hospitals. This covered a population of more than 7300 chronic HD patients. The study was conducted from October to December 2004. Response was obtained from 144 physicians (79.5%), working in 135 dialysis centers (92.5%) that totally treated 7107 (97%) HD patients in the KSA. Of the 144 respondents, 99 (72.8%) responded that they would use r-HuEPO therapy for all new HD patients not guided by hemoglobin (Hb) level. Almost all the respondents would start the patients on a weekly dose of 200 units/kg, while they would maintain the patients on a weekly dose of 150 units/kg. Written protocols to guide the administration of r­HuEPO were available in only half of the dialysis centers. A total of 83 respondents (58%) would aim at a target Hb of 110-120 g/l while 29 (20.3%) would go higher to 121-130 g/l. There were 51 (37.5%) respondents who considered multi-dose vials of the drug better for expense saving. There were 35 (24.8%) respondents who believed the type of r-HuEPO (alfa, beta) determines the development of the antibodies to r-HuEPO, while 84 (59.6%) had no idea. After regrouping of the respondents according to their affiliation, there was a significantly less percentage of the MOH centers which treated 70% of the dialysis patients with the drug in comparison with the non-MOH and private sector centers (81% vs 100%, respectively P 0.04). There was a significantly less percentage of MOH than the non­MOH centers to have a written protocol for administration of r-HuEPO (49.1% vs 95% respectively, P 0.0002). In conclusion, a protocol to guide the r-HuEPO therapy in HD patients is lacking in many centers of the KSA and there is a need for increased awareness of the physicians working in those centers in the practical aspects of the use of this drug in the treatment of anemia in this population