Abstract: SA-PO815

Low-Dose Iron Treatment and Erythropoiesis Efficiency in Hemodialysis Patients with Anemia Treated by Erythropoiesis-Stimulating Agents

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Kuji, Tadashi, Yokodai Central Clinic, Yokohama, Kanagawa, Japan
  • Suzuki, Shota, Yokohama City University, Yokohama, Kanagawa, Japan
  • Fujikawa, Tetsuya, Yokohama National University, Yokohama, Kanagawa, Japan

Anemia is a common comorbidity and is a major cause of morbidity and mortality among hemodialysis (HD) patients. Iron deficiency is a major cause of resistance to erythropoiesis-stimulating agents (ESA) therapy; however, excessive iron has toxic effects including oxidative stress. Even standard-dose parental iron supplementation causes oxidative stress due to free iron in the blood, therefore low-dose iron is desirable to reduce the free iron release for optimal prognosis. We aimed to investigate whether low-dose iron supplementation is as effective for erythropoiesis as standard-dose iron supplementation.


A randomized, controlled, parallel-group study was performed for six months. One hundred and two patients were randomized to receive 20mg intravenous elemental iron per week (Low-dose iron group: n = 53) or 40 mg intravenous elemental iron doses per week (Standard-dose iron group: n = 49). Ferritin and transferrin saturation were measured at two-month intervals. Iron was administered for two months when HD patients showed iron deficiency (transferrin saturation < 20% and ferritin < 100ng/ml). ESA resistance index was defined as the weekly weight-adjusted dose of ESA divided by hemoglobin concentration.


No significant differences in baseline characteristics except systolic blood pressure were evident between the two groups. The mean numbers of two-month long iron supplementation were 0.74 ± 0.83 in low-dose iron group and 0.49 ± 0.56 in standard-dose iron group. Mean Hb levels during the evaluation period of 6 months were 10.5 ± 0.4 g/dL in the low-dose iron group and 10.4 ± 0.4 g/dL in the standard-dose iron group (p = 0.315). There was a tendency toward low ESA dose in the low-dose iron group compared to the standard-dose iron group (4116.1 ± 2170.4 IU/week vs. 4935.1 ± 1792.8 IU/week, p = 0.079). There was a trend towards decrease in ferritin levels in low-dose iron group compared with the standard-dose iron group (-36.4±50.5 ng/mL vs. -11.8 ± 65.2 ng/mL, p = 0.073). Reticulocyte hemoglobin levels (newly synthesized hemoglobin) and ESA resistance index were not significantly different between the two groups.


Low-dose iron treatment suppresses ferritin levels, but does not decrease hemoglobin levels and reticulocyte hemoglobin levels or does not increase required ESA dose.