Among patients with end stage renal disease on hemodialysis therapy subcutaneous SC injection of lyophilized powder recombinant human erythropoietin EPO alfa is well tolerated and effectively maintains hemoglobin levels suggests a recent study published in the International Journal of Nephrology and Renovascular Disease. Anemia associated with chronic kidney disease CKD is often managed with recombinant human EPO. The present single blinded randomized controlled single center parallel group study evaluated the therapeutic equivalence between lyophilized powder and standard liquid EPO alfa by SC administration in hemoglobin maintenance among patients on hemodialysis. In all 63 anemic hemodialysis patients were given standard liquid or lyophilized powder EPO alfa for 24 weeks by SC administration. Baseline mean hemoglobin level was 11.1 0.7 g dL using lyophilized powder EPO alfa and 11.2 0.9 g dL using standard liquid EPO alfa. The baseline median dose of EPO alfa was 126.4 interquartile range IQR 81.6 163.6 U kg week in the lyophilized powder EPO alfa group and 116.9 IQR 76.5 144.1 U kg week in the standard liquid EPO alfa group. Treatment with SC lyophilized powder EPO alfa maintained mean hemoglobin and hematocrit concentrations following switch from standard liquid EPO alfa. There was no statistical significance between groups for hemoglobin concentrations and weekly dose of EPO alfa. There were no safety concerns raised. While SC injection of lyophilized powder EPO alfa was effective in maintaining hemoglobin levels in this study future studies of larger size and longer duration would help assess safety profiles.