Abstract: SA-PO824

Randomised Controlled Trial of Intravenous Iron versus Increased Erythropoietin in Haemodialysis Anaemia

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Hildebrand, Sarah, Imperial College Renal and Transplant Centre, London, lONDON, United Kingdom
  • Duncan, Neill D., Imperial College Renal and Transplant Centre, London, lONDON, United Kingdom
  • Tam, Frederick W.K., Imperial College Renal and Transplant Centre, London, lONDON, United Kingdom
  • Ashby, Damien, Imperial College Renal and Transplant Centre, London, lONDON, United Kingdom
Background

Anaemia in haemodialysis patients is treated with both erythropoietin and intravenous iron, but response rates are suboptimal, and treatment thresholds remain controversial. Despite poor reliability, traditional iron indices such as ferritin are usually used to guide treatment choices, whilst the relative effectiveness of the two available treatments has never been compared in a randomised trial.

Methods

Stable haemodialysis patients who became moderately anaemic (Hb 90-104g/l) on routine testing with non-extreme ferritin (100-800ng/l) were randomly allocated to treatment with either intravenous iron (1g divided over 5 consecutive sessions, IVFE group) or increased erythropoietin (starting 3000unit/week or median increase 50%, EPO group). No further treatment was given for 2 months.

Results

In 194 patients followed for up to 18 months (2438 patient-months observed), there were 160 anaemia episodes with completed randomisation and follow-up (mean age 63, 71% male). Intravenous iron and increased erythropoietin were equally effective: a positive haemoglobin response (increase by at least 5g/l by 2 months) was observed in 54/76 IVFE patients, and 62/84 EPO patients (71.1 vs 73.8%, p=0.7).

Factors predictive of treatment response were assessed in both groups. In the IVFE group, compared to non-responders, those achieving Hb response had lower hepcidin (101 vs 143ng/ml, p=0.031), lower mean cell volume (90.6 vs 94.5, p=0.034) and lower reticulocyte Hb (33.8 vs 35.5, p=0.047). In the EPO group only low CRP was predictive of a positive response (13.5 vs 28.6, p=0.038).

Ferritin was not predictive of response in either group (p=0.9 and 0.2 respectively). Weaker associations with response were found for gender, B12 levels, previous erythropoietin dose and warfarin use.

Conclusion

Intravenous iron and erythropoietin are equally effective in the majority of haemodialysis patients who become anaemic. Ferritin does not predict treatment response, but hepcidin and several established biomarkers do: in combination they could be used in an evidence-based protocol with improved response rates.

Funding

  • Private Foundation Support