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Abstract: TH-PO241

When It Comes to Intravenous Iron, More or Less, Outcomes Are Same

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Thiruvarudsothy, Srikanth, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Srikanth, Theesitha, West China School of Medicine, Chengdu , China
  • Michaud, Jennine, Veterans Administration , East Orange, New Jersey, United States
  • Yudd, Michael, Veterans Administration , East Orange, New Jersey, United States
Background

Intravenous (IV) iron supplementation is required in the management of anemia in most chronic hemodialysis patients. Although iron supplementation will replete iron stores and provide available iron to maximize effectiveness of erythropoietin stimulating agents (ESAs), it is a potent oxidant and known for having several potentially toxic side effects including worsening of infections and iron overload. Thus, lower doses of iron would be preferable, provided anemia is adequately managed and ESA requirements are not increased as a result.

Methods

In a single hemodialysis unit of 48 male veterans, we prospectively treated patients with standard dosing of IV sodium ferric gluconate (loading dose: 1000mg when transferrin saturation (Tsat) <20% and/or ferritin <100 μg/L or maintenance dose: 500mg when Tsat 20-50% and ferritin 100-800 μg/L), to maintain a hemoglobin (hb) level of 10-11 g/dL. Iron loading dose was 125mg IV with each dialysis treatment X 8 doses and maintenance dose was 125mg IV weekly X 4 weeks. The subsequent six months, iron dosing was reduced by half, and all other treatments were continued per protocol. Hb and iron parameters were assessed throughout the treatment periods, along with dosing requirements of erythropoietin and iron.

Results

There were no differences seen in the hb and iron profile during the standard vs reduced dosing periods, hb (mean 10.46 g/dL SD 1.57 vs mean 10.41 g/dL SD 1.39, p=0.72), Tsat (mean 22.83% SD 11.99 vs mean 24.76% SD 12.69, p=0.086) and ferritin (mean 565 μg/L SD 410 vs mean 606 μg/L SD 419, p=0.11). During the 6 month standard dosing period, 19.1% of the patients received IV iron and 23.8% during the reduced dosing period. The average amount of iron administered was 126.6mg/month in the standard dosing group and 51.2mg/month in the reduced dosing group. Erythropoietin dosage was similar during the two periods: 16,517 units/week (SD 8413) vs 14,064 units/week (SD 8612) respectively, p=0.055, however, more patients required erythropoietin treatment (32.8% vs 52.4%).

Conclusion

In our study population, iron stores were equally maintained during the standard dosing compared to a 50% reduction in IV iron administration, but more patients required ESA therapy. Implementation of a lower dosing IV iron regimen may mitigate potential adverse effects of iron supplementation without effecting iron stores.