Intravenous iron therapy in pediatric hemodialysis patients: a meta-analysis

Gillespie, Robert S.; Wolf, Fredric M.

doi:10.1007/s00467-004-1421-4

Cited by 39 publications

(19 citation statements)

References 12 publications

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“…More rapid bolus doses of IV iron are tolerated [7] and would reduce unnecessary clinic duration. The optimum dosing regimen of IV iron has not been established for any paediatric CKD patients [1,4]. There were insufficient patients to confidently examine this issue in this series.…”

Section: Discussionmentioning

confidence: 98%

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Intravenous iron treatment in paediatric chronic kidney disease patients not on erythropoietin

Morgan¹,

Holt²,

Jones³

et al. 2007

Pediatr Nephrol

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Intravenous (i.v.) iron treatment reduces erythropoietin (EPO) dose in paediatric haemodialysis patients. The efficacy in paediatric nonhaemodialysis patients is less well established. i.v. iron is routinely given in our institution to these patients, including some who have not started EPO. The effect of this strategy was examined. Patients with chronic kidney disease (CKD) or peritoneal dialysis (PD) not on EPO were identified. Case notes were reviewed for haemoglobin (Hb), red cell and iron indices for 6 months before and at least 3 months after i.v. iron. Five patients were identified. Mean age was 13.3 years and mean i.v. iron (Venofer) dose = 3.1 mg/kg. Median number of doses = 7 (range 3-10). Hb increased significantly after i.v. iron from 11.4 +/- 0.7 to 12.8 +/- 1.3 g/dl (p = 0.02). Mean cell volume increased from 87.7+/-3.4 to 90.1 +/- 3.7 fl (p = 0.01), and mean cell Hb remained unchanged: 29.2 +/- 1.2 to 29.7 +/- 1.0 pg (p = 0.12). Absolute and percentage reticulocyte count remained unchanged. There was no change in iron indices: ferritin 55.1 +/- 31.3 to 97.3 +/- 46.5 ng/ml (p = 0.3), iron 18.9 +/- 6.9 to 18.1 +/- 4.2 micromol/l (p = 0.7), transferrin 1.9 +/- 1.6 to 2.0 +/- 0.1 g/l (p = 1.0), transferrin saturation 35.7 +/- 8.1 to 40.3 +/- 18.0% (p = 0.5). i.v. iron slightly improved Hb levels in five paediatric CKD and PD patients not receiving EPO. This strategy may delay the need for EPO treatment and deserves further evaluation.

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Section: Discussionmentioning

confidence: 98%

“…Intravenous (IV) iron treatment increases haemoglobin (Hb) concentration and ferritin levels and reduces erythropoietin (EPO) dose in paediatric patients on haemodialysis (HD) [1]. This effect has been reported in adult patients on peritoneal dialysis (PD) [2] and in predialysis patients [3].…”

Section: Introductionmentioning

confidence: 98%

Intravenous iron treatment in paediatric chronic kidney disease patients not on erythropoietin

Morgan¹,

Holt²,

Jones³

et al. 2007

Pediatr Nephrol

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“…Prior meta-analyses have demonstrated a clear effect of intravenous iron therapy in raising the hemoglobin level and lowering the dose of ESA in hemodialysis patients with absolute iron deficiency anemia [4,5,6]. In recent years, however, clinical trials have demonstrated a short-term benefit of intravenous iron in raising hemoglobin and lowering ESA requirement in hemodialysis patients with functional iron deficiency anemia [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Iron therapy in hemodialysis patients has traditionally been targeted to maintain the transferrin saturation (TSAT) rate >20% [1,3] and serum ferritin at 200-500 ng/ml [1,3]. Several meta-analyses have demonstrated a superior benefit of intravenous over oral iron therapy in raising the hemoglobin level and decreasing the requirement for erythropoiesis-stimulating agents (ESA) in dialysis patients with absolute iron deficiency anemia as defined by a TSAT rate <20% and serum ferritin <200 ng/ml [4,5,6]. However, in recent years, there has been a trend to administer intravenous iron to hemodialysis patients with less clear indications, i.e.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Intravenous Iron Therapy for Functional Iron Deficiency Anemia in Hemodialysis Patients: A Meta-Analysis

Susantitaphong¹,

Alqahtani²,

Jaber³

2014

Am J Nephrol

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Background: Studies on benefits of intravenous iron therapy among hemodialysis patients with functional iron deficiency anemia have shown conflicting results. We conducted a meta-analysis to assess the efficacy and safety of intravenous iron in this subset of patients. Methods: We searched MEDLINE (through December 2012), the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for single-arm studies and randomized controlled trials (RCT) that examined the effect of intravenous iron for functional iron deficiency anemia in hemodialysis patients on anemia parameters and markers of oxidative stress and inflammation. Studies of absolute iron deficiency were excluded. Random-effect model meta-analyses were used to compute changes in outcomes of interest. Results: We identified 34 studies (2,658 patients), representing 24 single-arm studies, and 10 parallel-arm RCT. In the analyses of the study arms, intravenous iron therapy resulted in a significant increase in hemoglobin, serum ferritin, transferrin saturation rate, serum iron, reticulocyte hemoglobin content as well as a significant decrease in the percentage of hypochromic erythrocytes and erythropoietin dose. There were significant increases in plasma malonyldialdehyde level and thiobarbituric acid-reactive substances, and a decrease in neutrophil respiratory burst. The analyses of the RCT revealed less robust net changes in these parameters, and there was no increased risk of adverse events including infections, cardiac events and mortality. Conclusions: Intravenous iron therapy for functional iron deficiency anemia in hemodialysis patients improves anemia parameters but exerts some effects on markers of oxidative stress that are of unclear clinical significance. The long-term safety and efficacy of this treatment strategy requires further study.

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“…No existe actualmente un consenso respecto a la dosis y frecuencia de administración de hierro intravenoso en población pediátrica 3,62 . La dosificación apropiada es un tema complejo de establecer, principalmente porque existen escasos estudios realizados en población pediá-trica, la mayoría de los cuales incorporan un número pequeño de pacientes y fueron realizados en pacientes en hemodiálisis.…”

Section: Dosificaciónunclassified

Tratamiento de la anemia con eritropoietina y hierro en Enfermedad Renal Crónica

2008

Rev. chil. pediatr.

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Erythropoietin and iron in anemia management in chronic renal failureAnemia is one of the most common manifestations of Chronic Renal Failure (CRF), specially during the dialysis period. Growth failure and a high cardiovascular morbimortality are 2 of the most important consequences. Objective: To present a review of the current concepts in diagnosis and management of anemia in pediatric CRF patients. Erythropoietin (EPO) deficit is the main cause of anemia, requiring exogenous replacement through intravenous or subcutaneous route, in hemodialyzed or peritoneodialyzed patients respectively. A longer half-life allows to use EPO one or twice weekly when given by intraperitoneal route, in order to reach a target hemoglobin between 11-12 gr/dl, a level that avoids the cardiovascular risk associated to higher levels as described in adult CRF population. In pediatrics, 100-300 U/kg/weekly can be used to reach the desired hemoglobin levels, always monitoring about the potential complications of EPO, specially arterial hypertension. If anemia seems to be resistent to EPO therapy, iron deficit should be considered and properly treated, as described in this article. Ferritin and saturation of hemoglobin need to be routinely monitored to diagnose iron status in these patients, values less than 100 ng/ml and 20% respectively require exogenous suplementation. Iron doses in pediatrics still need to be defined. Anemia needs to be evaluated and treated in all CRF children, properly management must always be instaured in order to prevent its undesired effects.

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Intravenous iron therapy in pediatric hemodialysis patients: a meta-analysis

Cited by 39 publications

References 12 publications

Intravenous iron treatment in paediatric chronic kidney disease patients not on erythropoietin

Intravenous iron treatment in paediatric chronic kidney disease patients not on erythropoietin

Efficacy and Safety of Intravenous Iron Therapy for Functional Iron Deficiency Anemia in Hemodialysis Patients: A Meta-Analysis

Tratamiento de la anemia con eritropoietina y hierro en Enfermedad Renal Crónica

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