OBJECTIVES: To compare the use of intravenous (IV) versus subcutaneous (SC) Eprex maintenance therapy in the chronic kidney disease (CKD) population in Canada. METHODS: Retrospective chart review of patients with CKD. Patients included if: 1) receiving Eprex for anemia associated with CKD for at least 6 months; 2) were stable on current renal replacement modality (i.e., predialysis, peritoneal dialysis, hemodialysis) for at least 6 months. Patients were excluded if treated for less than 2 months via the current route of administration. Patients were randomly selected from patient lists generated from each of the sites. If a patient did not fulfill inclusion and exclusion criteria, the immediate next patient was evaluated for inclusion. This analysis focused on all hemodialysis patients treated with IV (n = 28) or SC (n = 166). Difference in dose was analyzed by analysis of covariance controlling for age, sex, presence of diabetes, use of ACE Inhibitors, history of cancer, and route of administration. RESULTS: Mean dose (±standard deviation) for patients treated with SC Eprex was 159 IU/kg/week (±124 IU/kg/week) as compared to a mean dose of 124 IU/kg/week in IV patients (±112 IU/kg/week). Neither the unadjusted difference (p = 0.160), nor the difference adjusted for the pre-defined covariates (p = 0.852) were significantly different between the two routes of administration. The cost of Eprex for SC treatment ($147/week ± $103) versus IV therapy ($133/week ± $110) was not significantly different (p = 0.496). No difference was detected in hemoglobin levels between SC (115.4g/L) and IV (113.6g/L) patients (p = 0.515). These results are limited by the small sample of patients in the IV group as well as by the fact that all IV patients were found in a single hemodialysis unit. This analysis indicates that further research may be necessary to optimize the dosing of biologic agents such as Eprex. CONCLUSIONS: Route may not play a significant role in the Eprex dose required for treating anemia in CKD patients.