Reduction in erythropoietin doses by the use of chronic intravenous iron supplementation in iron-replete hemodialysis patients

Chang, Chung Hsing; Chang, Chun-Kang; Chiang, S S

doi:10.5414/cnp57136

Cited by 36 publications

(30 citation statements)

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“…Indeed, studies consistently show that administering IV iron increases hemoglobin and reduces ESA doses (31)(32)(33)(34)(35)(36), even among patients with serum ferritin=500-1200 ng/ml (37,38). Given the range of documented and speculated toxicities of ESAs (39)(40)(41), it is possible that avoiding higher ESA doses by giving more IV iron may be of net benefit to patients, even if there were a modest increase in the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Iron Exposure and Mortality in Patients on Hemodialysis

Miskulin¹,

Tangri²,

Bandeen‐Roche³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Clinical trials assessing effects of larger cumulative iron exposure with outcomes are lacking, and observational studies have been limited by assessment of short-term exposure only and/or failure to assess cause-specific mortality. The associations between short-and long-term iron exposure on all-cause and cause-specific mortality were examined.Design, setting, participants, & measurements The study included 14,078 United States patients on dialysis initiating dialysis between 2003 and 2008. Intravenous iron dose accumulations over 1-, 3-, and 6-month rolling windows were related to all-cause, cardiovascular, and infection-related mortality in Cox proportional hazards models that used marginal structural modeling to control for time-dependent confounding.Results Patients in the 1-month model cohort (n=14,078) were followed a median of 19 months, during which there were 27.6% all-cause deaths, 13.5% cardiovascular deaths, and 3% infection-related deaths. A reduced risk of all-cause mortality with receipt of .150-350 (hazard ratio, 0.78; 95% confidence interval, 0.64 to 0.95) or .350 mg (hazard ratio, 0.79; 95% confidence interval, 0.62 to 0.99) intravenous iron compared with .0-150 mg over 1 month was observed. There was no relation of 1-month intravenous iron dose with cardiovascular or infectionrelated mortality and no relation of 3-or 6-month cumulative intravenous iron dose with all-cause or cardiovascular mortality. There was a nonstatistically significant increase in infection-related mortality with receipt of .1050 mg intravenous iron in 3 months (hazard ratio, 1.69; 95% confidence interval, 0.87 to 3.28) and .2100 mg in 6 months (hazard ratio, 1.59; 95% confidence interval, 0.73 to 3.46).Conclusions Among patients on incident dialysis, receipt of #1050 mg intravenous iron in 3 months or 2100 mg in 6 months was not associated with all-cause, cardiovascular, or infection-related mortality. However, nonstatistically significant findings suggested the possibility of infection-related mortality with receipt of .1050 mg in 3 months or .2100 mg in 6 months. Randomized clinical trials are needed to assess the safety of exposure to greater cumulative intravenous iron doses.

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Section: Discussionmentioning

confidence: 99%

Intravenous Iron Exposure and Mortality in Patients on Hemodialysis

Miskulin¹,

Tangri²,

Bandeen‐Roche³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…1) [7,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58], representing 24 single-arm or cohort studies and 10 parallel-arm RCT; 32 studies (94%) were published in full-text articles and 2 (6%) were scientific abstracts. The characteristics of the individual studies are displayed in table 1.…”

Section: Resultsmentioning

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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“…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%

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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Reduction in erythropoietin doses by the use of chronic intravenous iron supplementation in iron-replete hemodialysis patients

Cited by 36 publications

References 0 publications

Intravenous Iron Exposure and Mortality in Patients on Hemodialysis

Intravenous Iron Exposure and Mortality in Patients on Hemodialysis

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

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

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