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Kidney Week

Abstract: TH-PO240

Real World Experience: A Conversion of Haemodialysis Patients from Iron Sucrose to Iron Isomaltoside

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Jesus Silva, Jorge, University Hospitals of Leicester, Leicester, United Kingdom
  • Burton, James, University Hospitals of Leicester, Leicester, United Kingdom
Background

Anaemia is common in haemodialysis (HD) patients, and associated with significant morbidity and mortality. Intravenous (IV) iron combined with erythropoietin (EPO) is the mainstay treatment of anaemia in these patients. Iron isomaltoside 100, 5% (Diafer) is the newest IV iron available to HD patients in the UK.
Objective: To assess the efficacy and safety of converting patients from iron sucrose (IS) to iron isomaltoside (IIM).

Methods

The clinical notes of 880 HD patients were retrospectively reviewed for the period between September 2015 - April 2017. 633 were prescribed IIM of which 97 patients made a direct switch from IS to IIM. Haemoglobin (Hb), ferritin (FER), transferrin saturation (TSAT), and EPO dose were collected 1 month before conversion (T-1), month of first IIM dose (T0), 6 (T6) and 12 (T12) months post conversion. ANOVA or Friedman tests were used for statistical analyses with post-hoc adjustment for multiple comparisons using T0 as control.

Results

Differences in clinical variables are shown in the table. There was a statistically significant effect on Hb over time although after converting (T0), there was no significant change at 6 or 12 months. There were significant improvements in ferritin and TSAT over time, which remained at 6 months for both (P<0.01) and at 12 months for TSAT (P<0.05). There was an overall decrease in weekly iron dose that was significant at 12 months (P=0.02) and no change in EPO dose. In total there were 28,125 prescriptions of IIM and 8,145 of IS with no difference in reported adverse events during the audit period (6 each, none required adrenaline).

Conclusion

Hb, TSAT and FER were maintained at satisfactory levels for at least 12 months post-conversion, indicating that the drugs have similar efficacy with no difference in reported adverse events.

 T -1T0T6T12P value
Hb (g/L)
(M / SD)
108.5±13.7112±13.7114.3±12.2111.7±10.9<0.01
Ferritin (ug/L)
(mdn / IQR)
305 (204-398)288 (204-404)374 (255-490)338 (220-447)0.01
TSAT (%)
(mdn / IQR)
21.5 (16-28)20 (15-27)25.5 (19-34)24 (16-32)<0.001
Weekly Fe dose (mg)
(mdn / IQR)
50 (50-100)50 (50-50)50 (25-100)50 (25-50)<0.001
Weekly EPO dose (U)
(mdn / IQR)
9000 (4000-12000)9000 (4000-12000)6000 (3000-12000)8000 (3000-12000)0.4