Beneficial effects of adopting an aggressive intravenous iron policy in a hemodialysis unit

Macdougall, Iain C.; Chandler, Georgina; Elston, Orlaith; Harchowal, Jatinder

doi:10.1053/ajkd.1999.v34.aajkd0344b0040

Cited by 61 publications

(37 citation statements)

References 24 publications

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“…Other investigators have tested various parenteral maintenance iron regimes [8][9][10][11][12][15][16][17][18][19][20]. However, most studies have been performed in iron-deficient patients or in patients with functional iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas it seems clear that iron-deficient haemodialysis patients need initial iron loading, the maintenance dosing schedule for iron-replete patients still needs to be defined [8]. Based on the results from several studies, a relatively broad dosing range from 25 to 150 mg/week has been recommended [8][9][10][11][12]. With such a broad dosing range there is on the one side a risk of underdosing and also a risk of iron overload on the other [13].…”

Section: Introductionmentioning

confidence: 99%

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Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients

Schiesser¹,

Binet²,

Tsinalis³

et al. 2006

Nephrology Dialysis Transplantation

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Background. Haemodialysis patients need sustained treatment with intravenous iron because iron deficiency limits the efficacy of recombinant human epoetin therapy in these patients. However, the optimal intravenous iron maintenance dose has not been established yet. Methods. We performed a prospective multicentre clinical trial in iron-replete haemodialysis patients to evaluate the efficacy of weekly low-dose (50 mg) intravenous iron sucrose administration for 6 months to maintain the iron status, and to examine the effect on epoetin dosage needed to maintain stable haemoglobin values in these patients. Fifty patients were enrolled in this prospective, open-label, single arm, phase IV study. Results. Forty-two patients (84%) completed the study. After 6 months of intravenous iron sucrose treatment, the mean ferritin value showed a tendency to increase slightly from 405 AE 159 at baseline to 490 AE 275 mg/l at the end of the study, but iron, transferrin levels and transferrin saturation did not change. The haemoglobin level remained stable (12 AE 1.1 at baseline and 12.1 AE 1.5 g/dl at the end of the study). The mean dose of darbepoetin alfa could be reduced from 0.75 to 0.46 mg/kg/week; epoetin alfa was decreased from 101 to 74 IU/kg/week; and the mean dose of epoetin beta could be reduced from 148 to 131 IU/kg/week at the end of treatment. Conclusions. A regular 50 mg weekly dosing schedule of iron sucrose maintains stable iron stores and haemoglobin levels in haemodialysed patients and allows considerable dose reductions for epoetins. Low-dose intravenous iron therapy may represent an optimal approach to treat the continuous loss of iron in dialysis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients

Schiesser¹,

Binet²,

Tsinalis³

et al. 2006

Nephrology Dialysis Transplantation

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“…23,24) Iron saccarate is considered a safe and efficacious preparation. 25,26) However, parenteral iron overload has been linked with tissue deposition of iron, and potentially can increase oxidative stress, thereby inducing cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

<b>Intravenous Iron Therapy as a Possible Risk Factor for Atherosclerosis in End-stage Renal Disease</b>

et al. 2005

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SUMMARYAtherosclerosis is a disease of the arterial wall, with increasing wall thickness representing an early event in the progression of the disease. It has been suggested that iron overload, as assessed by increased serum ferritin concentration, may be a risk factor for atherosclerosis.The aim of this study was to investigate the relationship between the influence of intravenous (IV) iron therapy and ferritin levels and carotid intima media thickness (C-IMT) in dialysis patients. Sixty patients (51 ± 14) years were divided into two groups according to their IMT obtained by ultrasound; group I (high risk) and group II (low risk). The parameters assessed were serum creatinine, urea, calcium, phosphorus, hemoglobin, albumin, uric acid, iron, ferritin, and lipid levels. Thirty-eight patients (88%) in group I and 5 patients (12%) in group II received IV iron therapy while 5 patients (29%) in group I and 12 patients (71%) in group II (P < 0.001) did not receive IV iron therapy. Ferritin levels were higher in group I than in group II (581 ± 303 and 306 ± 224) (P < 0.001). C-IMT measurements correlated with serum ferritin and with the intravenous iron dose received during the 24 months preceding the study (r = 0.315, P = 0.015; r = 0.471, P = 0.001).The findings indicate that IV iron therapy and elevated serum ferritin levels may cause an increase in the incidence of atherosclerosis. (Int Heart J 2005; 46: 255-264)

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“…Although parenteral iron preparations are widely used, only few published studies explore the effects of intravenous iron treatment in iron-repleted patients on HD (table 1) [9,10,28,29,30,31]. …”

Section: Discussionmentioning

confidence: 99%

Low-Molecular-Weight Iron Dextran in the Management of Renal Anaemia in Patients on Haemodialysis – the IDIRA Study

Rath

Florschütz²,

Kalb³

et al. 2009

Nephron Clin Pract

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Background: Intravenous iron supplementation is a basic principle in the therapy of haemodialysis (HD) patients with renal anaemia. In the Iron Dextran in Renal Anaemia (IDIRA) study, we analysed the efficacy of a therapy with low-molecular-weight iron dextran (LMW-ID) in stable HD patients with adequate iron stores previously treated with ferric gluconate. Methods: IDIRA was an open-label, prospective, non-randomized, observational multicenter trial over 12 months in iron-repleted HD patients. All patients were treated with intravenous LMW-ID. Measures of efficacy were changes of haemoglobin (Hb), serum ferritin, erythropoietin dose and the response to iron therapy calculated as ferritin efficacy and Hb efficacy. Statistical analysis was done by the Wilcoxon test. Results: A total of 221 HD patients with a mean age 63.7 ± 13.8 years were included. A total of 208 out of 221 patients were on erythropoietin therapy. Median time on dialysis was 2 (1–4) years. Mean Kt/V was 1.3. Of the 221 patients, 208 completed the 12-month study period. Mean Hb and serum ferritin increased without the need for higher erythropoietin doses. The mean amount of iron per week administered remained stable. Ferritin efficacy and Hb efficacy improved using LMW-ID (p < 0.01). Conclusions: We conclude that LMW-ID improves anaemia management even in iron-pretreated HD patients.

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Beneficial effects of adopting an aggressive intravenous iron policy in a hemodialysis unit

Cited by 61 publications

References 24 publications

Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients

Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients

<b>Intravenous Iron Therapy as a Possible Risk Factor for Atherosclerosis in End-stage Renal Disease</b>

Low-Molecular-Weight Iron Dextran in the Management of Renal Anaemia in Patients on Haemodialysis – the IDIRA Study

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