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Kidney Week

Abstract: TH-OR027

Maintenance Intravenous Iron Treatment on Erythropoietin Dose in Chronic Hemodialysis Patients: A Multicenter Randomized Controlled Trial

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Susantitaphong, Paweena, Chulalongkorn University, Bangkok, Thailand
  • Siribumrungwong, Monchai, Lerdsin Hospital, Bangkok, Thailand
  • Takkavatakarn, Kullaya, Division of Nephrology, King Chulalongkorn Memorial hospital, Bangkok, Thailand
  • Lewsuwan, Songkiat, Chulalongkorn University, Bangkok, Thailand
  • Katavetin, Pisut, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • Tiranathanagul, Khajohn, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Lekhyananda, Sookruetai, The Kidney Foundation of Thailand, Bangkok, Thailand
  • Tungsanga, Kriang, King Chulalong Memorial lHospital, Bangkok, Thailand
  • Vanichakarn, Supat, The Kidney Foundation of Thailand, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
Background

Although the benefits of intravenous iron (IV) treatment in chronic hemodialysis (HD) patients were demonstrated in recent studies, IV iron regimens for optimal target levels of iron status are still not established in several guidelines. To explore these questions, we conducted a multicenter, randomized, open label study to demonstrate the effectiveness of IV iron supplement on erythropoietin dose in chronic HD patients.

Methods

Two hundred adult chronic HD patients with transferrin saturation less than 30%, and serum ferritin 200-400 ng/mL, receiving recombinant erythropoietin were randomized 1:1 for maintaining serum ferritin of 200-400 ng/mL (low serum ferritin group, N=100) or serum ferritin of 600-700 ng/mL (high serum ferritin, N=100). During 8-week titration period, subjects randomized to high serum ferritin group received total IV iron of 600 mg (100 mg every week), whereas the subjects in low serum ferritin group did not obtain initial IV iron. During 6-month follow up period, the dose of IV iron was adjusted following the protocol. The primary endpoint was to evaluate the efficacy of IV iron supplement on erythropoietin dose index [erythropoietin dose (unit/week) divided by hemoglobin level (g/dL)]. The study was registered with the Thai Clinical Trials Registry TCTR20180903003.

Results

The mean dose of IV supplement was 108.3±28.2 mg/month in low ferritin group and 192.3±36.2 mg/month in high ferritin group. The mean serum ferritin was 367.0±224.9 ng/mL in low ferritin group and 619.6±265.2 ng/mL in high ferritin group. At 3-month follow up, the erythropoietin index was significantly decreased in high serum ferritin group when compared with low serum ferritin group (921.4±369.1 vs. 756.1±372.2 unit/week/g/dL, P=0.002, and 873.8±329.4 vs. 767.9±392.1 unit/week/g/dL, P=0.05, respectively). At 6-month follow up, only high serum ferritin group showed a significant decrease of erythropoietin index from randomization (854.0±371.7 to 765.3±368.0 unit/week/g/dL, P<0.001).

Conclusion

Maintaining serum ferritin of 600-700 ng/mL by IV iron treatment approximately 200 mg per month can decrease erythropoietin dose in chronic HD patients.

Funding

  • Government Support - Non-U.S.