EurekaMag.com logo
+ Site Statistics
References:
53,869,633
Abstracts:
29,686,251
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

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



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



Clinical Nephrology 57(2): 136-141



Iron deficiency is the most common cause of suboptimal response to recombinant human erythropoietin (rHuEPO) in chronic hemodialysis (HD) patients. Iron supply can correct this situation, however, optimal dosage, route of administration, and monitoring of iron status during rHuEPO therapy in maintenance HD patients remains controversial. We conducted a 12-month intravenous iron substitution trial in 149 iron-replete chronic HD patients receiving subcutaneous rHuEPO therapy. The available iron pool was maintained with 100 mg iron every 2 weeks or 1 month depending on serum ferritin and transferrin saturation levels, the rHuEPO dosage titrated depending on hematocrit (Hct) levels. After 12-month protocol, the Hct increased (28.7 +/- 4.1 vs 27.7 +/- 2.6, p = 0.003), rHuEPO requirement reduced 25% (46.1 +/- 28.9 vs 61.5 +/- 67.8 U/kg/week, p = 0.006), serum ferritin increased (1,383 +/- 727 vs 930 +/- 857 ng/ml, p < 0.001), so did the transferrin saturation (36.1 +/- 12.7 vs 27.5 +/- 12.8%, p < 0.001). The serum albumin decreased slightly but reached statistical significance (4.1 +/- 0.48 vs 4.2 +/- 0.36 g/dl, p = 0.006), so did the cholesterol levels (166 +/- 41 vs 173 +/- 38 mg/dl, p = 0.044) and pre-dialysis creatinine (11.3 +/- 2.3 vs 11.5 +/- 2.4 mg/dl, p = 0.015). Besides, the iPTH levels did not interfere with the rHuEPO dosage reduction and Hct increment in our patients. We conclude that maintaining high levels of serum ferritin and transferrin saturation could further reduce the requirement of rHuEPO in chronic HD patients, but the long-term effect of iron overloading to patients' nutritional status must be further evaluated in contrast to the economic saving.

(PDF emailed within 1 workday: $29.90)

Accession: 047201652

Download citation: RISBibTeXText

PMID: 11863124



Related references

Reduction in recombinant human erythropoietin doses by the use of chronic intravenous iron supplementation. American Journal of Kidney Diseases 26(6): 1000; Author Reply 1001-1000; Author Reply 1001, 1995

Intravenous iron reduces erythropoietin use and improves iron indices in hemodialysis patients with functional iron deficiency. Journal of the American Society of Nephrology 14(Abstracts Issue): 706A, November, 2003

Effect of weekly or successive iron supplementation on erythropoietin doses in patients receiving hemodialysis. Nephron 89(1): 110-112, 2001

A cross-over comparison of the efficacy of intravenous and subcutaneous erythropoietin in hemodialysis patients on iv iron supplementation. Blood Purification 15(SUPPL 2): 25, Sept, 1997

Iron-replete hemodialysis patients do not require higher EPO dosages when converting from subcutaneous to intravenous administration: results of the Italian Study on Erythropoietin Converting (ISEC). American Journal of Kidney Diseases 47(6): 1027-1035, 2006

Maintenance parenteral iron supply in the treatment of anemia in iron-replete chronic hemodialysis patients. Journal of the American Society of Nephrology 9(PROGRAM AND ABSTR ISSUE): 232A, Sept, 1998

Effect of intravenous iron utilization on erythropoietin doses and hematocrit levels in prevalent hemodialysis patients. Journal of the American Society of Nephrology 12(Program and Abstract Issue): 247A-248A, September, 2001

Iron sucrose and ascorbic acid supplementation improves responsiveness to erythropoietin in functional iron deficient hemodialysis patients. Journal of the American Society of Nephrology 10(PROGRAM AND ABSTR ISSUE): 299A, Sept, 1999

The relationship between red cell distribution width with erythropoietin resistance in iron replete hemodialysis patients. European Journal of Internal Medicine 24(3): E25-E29, 2013

Effect of an intravenous iron dextran regimen on iron stores, hemoglobin, and erythropoietin requirements in hemodialysis patients. American Journal of Kidney Diseases 31(5): 835-840, 1998

Comparative response to single or divided doses of parenteral iron for functional iron deficiency in hemodialysis patients receiving erythropoietin (EPO). Clinical Nephrology 49(1): 45-48, 1998

Once weekly low dose intravenous iron dextran improves the erythrogenic response to erythropoietin in iron deficient hemodialysis patients. Journal of the American Society of Nephrology 9(PROGRAM AND ABSTR ISSUE): 221A, Sept, 1997

Acute oxidative stress following intravenous iron injection in patients on chronic hemodialysis: a comparison of iron-sucrose and iron-dextran. Nephron. Clinical Practice 118(3): C249-C256, 2011

Recombinant human erythropoietin resistance in iron-replete hemodialysis patients: role of aluminum toxicity. American Journal of Nephrology 18(1): 1-8, 1998

Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients. Nephrology, Dialysis, Transplantation 21(10): 2841-2845, 2006