Abstract: SA-PO812

Intravenous Regular Administration of 40mg Iron a Month Might Reduce Hemoglobin Variability of Hemodialysis Patients in Japan

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Author

  • Tsukamoto, Tatsuo, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, KYOTO, Japan
Background

Japanese hemodialysis patients show relatively lower ferritin level than that of other countries, although their TSATs (transferrin saturation) are more than 20%. I have measured iron loss by iron contents of residual blood in the blood tubing set and dialyzer, and estimated that 500mg of iron would be lost by routine hemodialysis procedure in Japan (Am J Nephrol 2016,43,32-38). In this study, I show here the stable iron status as well as hemoglobin (Hb) level by regular administration of 40mg iron a month. Moreover, I demonstrate the reduction of Hb variability by the supplementary protocol.

Methods

157 patients of Otowa Memorial Hospital were enrolled after informed consent. Men were consisted in 64.7%, and the mean age was 69.2±13.5 (m±SD). 40.4% was diabetic. 40mg of iron (saccharated ferric oxide) was intravenously administered once a month after hemodialysis session. Hb, TSAT, and ferritin were monitored every month before and after the regular iron supplementation. Hb variability was counted in each patient by the Fishbane’s method described in the previous paper (Kidney International 2005,68, 1337-1343). ERI (erythropoiesis resistance index) was also calculated with human recombinant erythropoietin (rHuEPO) dose in a month divided by Hb and body weight (dry weight). Erythropoiesis-stimulating agents (ESAs) used in this study were rHuEPO, darbepoetin-a (DA), and continuous erythropoietin receptor activator (CERA). DA was converted to 200U, and CERA was 240U of rHuEPO, respectively. The dose of ESA was determined by an attending physician along the Japanese guideline for renal anemia in chronic kidney disease 2008.

Results

Hb levels kept from 11.2±1.0g/dL at the beginning to 10.9±1.0g/dL after 12 months. TSAT and ferritin did not change from 26.3±12.2% and 88.9±86ng/mL to 25.7±9.9% and 77.6±94.6ng/mL, respectively. ERI changed from 40.5±36.1 to 39.6±32.6. Although iron status and ERI did not changed significantly, Hb variability reduced from 120 times per 6 months before the regular iron administration to 98 times after 6 months and 81 times after 1 year.

Conclusion

Intravenous regular administration of 40mg iron a month might reduce hemoglobin variability of hemodialysis patients without significant change of iron status In Japan.

Funding

  • Private Foundation Support