Iron therapy in the pediatric hemodialysis population

Abstract

Iron therapy maintains iron stores and optimizes the response to recombinant human erythropoietin (r-HuEPO) in patients with end-stage renal failure. Information is limited, however, regarding the preferential route of iron administration in pediatric patients receiving hemodialysis. Therefore, we prospectively randomized 35 iron-replete patients (aged >1 to <20 years) to receive up to 16 weeks of maintenance i.v. ( n=17) or daily oral ( n=18) iron. Eligible patients had received hemodialysis for >2 months, had a baseline transferrin saturation [TSAT] >20%, and were receiving maintenance r-HuEPO. Treatment arms were evenly distributed with respect to baseline demographic and clinical characteristics, with no statistically significant differences in baseline hemoglobin (Hb), hematocrit (Hct), reticulocyte Hb content (CHr), serum ferritin (SF), TSAT, or r-HuEPO dose. In the 35 patients, i.v. iron dextran and not oral iron was associated with a significant increase (138.5 to 259.1 ng/ml, P=0.003) in SF. A comparison of the change in SF between the i.v. iron group and the oral iron group was also significant ( P=0.001). Whereas only i.v. iron was associated with a significant decrease in the dose of r-HuEPO (234.0 to 157.6 U/kg per week, P=0.046) and an increase of the CHr (29.2 to 30.1 pg, P=0.049), these changes were not significantly different from those experienced by patients in the oral iron group. In both groups, the Hct remained stable and in neither group was there a significant change in the TSAT. In summary, although both oral and i.v. iron maintained patients in an iron-replete state in this short-term study, only i.v. therapy allowed for a significant improvement in iron stores.

Evaluation of erythrocyte and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease

“… 6,10,11 Measurement of the reticulocyte content is helpful in detecting early stages of iron deficiency prior to the development of anemia. 6,12,13 A reduction in reticulocyte hemoglobin has been observed in other conditions besides iron deficiency, such as in hemoglobinopathies. 14,15 …”

FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia

“…In patients receiving haemodialysis, IV iron has been shown to be significantly more effective than oral iron for replenishing depleted iron stores, improving Hb levels and reducing dosage requirements for ESAs [ 13 – 18 ]. However, in patients with non-dialysis-dependent CKD, the evidence base supporting optimal iron management is notably inadequate, as demonstrated by both a recent meta-analysis of oral versus IV iron in this patient population which included only six studies [ 19 ] and a Cochrane review, which included 10 studies [ 20 ] of relatively small size and short duration.…”

Evaluation of red cell and reticulocyte parameters as indicative of iron deficiency in patients with anemia of chronic disease

“… 6,10,11 Measurement of the reticulocyte content is helpful in detecting the earliest stages of iron deficiency, prior to the development of anemia. 6,12,13 The reduction in reticulocyte hemoglobin has been observed in other conditions besides iron deficiency, such as in hemoglobinopathies. 14,15 …”