Journal Article

Regular low-dose intravenous iron therapy improves response to erythropoietin in haemodialysis patients

J. E. Taylor, N. Peat, C. Porter and A. G. Morgan

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 11, issue 6, pages 1079-1083
Published in print June 1996 | ISSN: 0931-0509
e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/oxfordjournals.ndt.a027459
Regular low-dose intravenous iron therapy improves response to erythropoietin in haemodialysis patients

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Background.

Erythropoietin (Epo) is an effective but expensive treatment for anaemia in patients with chronic renal failure. Hyporesponsiveness to Epo, particularly in haemodialysis patients, is most commonly due to a functional iron deficiency, which is difficult to monitor reliably.

Methods.

Forty-six stable haemodialysis patients, receiving Epo therapy, were commenced on regular low-dose intravenous iron (sodium ferric gluconate complex) at a dose of 62.5 mg/5 ml given as a slow injection post-dialysis twice weekly, weekly, or fort-nightly, according to their serum ferritin levels. Haemoglobin, serum ferritin, Epo dose, and iron dose were measured at 6-weekly intervals over a 6-month period.

Results

At the beginning of the study, 12 patients in the group had ferritin levels of less than 100 μg/l, and were thus considered to potentially have an absolute iron deficiency. The study group was therefore split into two subgroups for the purpose of analysis, i.e. the 12 patients with ferritin levels of less than 100 μg/l at the start of the study or ‘low ferritin group’, and the remaining 34 patients with ferritin levels of greater than 100 μg/l at the start of the study or ‘normal ferritin group’.

In the low ferritin group (n=12), intravenous iron therapy increased serum ferritin levels, and produced a significant rise in haemoglobin, and a significant reduction in Epo dose. (Ferritin pre-iron, median (range) 68 (20–96)μg/l; post-iron, 210.5 (91–447)μg/l, P<0.003, Wilcoxon. Haemoglobin pre-iron, 10.05 (8.2–11.9)g/dl; post-iron, 11.0 (9.9–11.9)g/dl, P<0.03. Epo dose pre-iron, 9000 (4000–30000) i.u./week; post-iron, 6000 (2000–10000)i.u./week, P<0.05.)

Similar results were obtained in the normal ferritin group (n=34) following intravenous iron therapy, with significant increases in serum ferntin levels and haemoglobin concentrations, and a significant reduction in Epo dose. (Ferritin pre-iron, 176 (103–519) μg/l; post-iron, 304.5 (121–792)μg/l, P<0.0001. Haemoglobin pre-iron, 9.85 (6.5–12.8)g/dl; post-iron: 11.25 (9.9–13.3)g/dl, P<0.0001. Epo dose pre-iron, 6000 (2000–15 000)i.u./week; post-iron, 4000 (0–15000)i.u./week, P<0.005.)

Conclusion.

Regular intravenous iron supplementation in haemodialysis patients improves the response to Epo therapy.

Keywords: erythropoietin; intravenous iron; haemodialysis

Journal Article.  0 words. 

Subjects: Nephrology

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