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Abstract: PO0282

Predicting the Optimal Approach to IV Iron: Understanding the Requirements to Attain and Maintain Target Haemoglobin in Non-Haemodialysis CKD

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Brown, Christopher, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, United Kingdom
  • Mikhail, Ashraf I., Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, United Kingdom
  • Cameron, Felicity Paige, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, United Kingdom
  • Greene, Giles, Cardiff University, Cardiff, South Glamorgan, United Kingdom
Background

The UK Renal Association recommends a High-dose Low-frequency (HDLF) approach to IV iron management for non-haemodialysis (non-HD) CKD. HDLF is defined as at least 500mg per infusion with a maximum of two infusions. Reducing the frequency of repeat infusion benefits healthcare resource & patient acceptance. This study retrospectively examined IV iron strategies used to attain & maintain effective treatment response.These data may predict a future dosing strategy that is more likely to meet iron requirements in a single, or at least a minimum number of infusions.

Methods

This retrospective analysis of 170 non-HD patients examined a 12 month Hb response to a single infusion of iron isomaltoside (HDLF1); max permissible 20mg/kg/infusion. The cumulative amount of iron to attain and maintain a target Hb >100g/L was determined.

Results

Of the 170 patients 111 (65%) attained a Hb target of 100g/L with a mean single infusion dose (HDLF1) of 985mg (equating to 11.9mg/kg); the mean time to Hb target was 91 days. Repeat doses were defined as either HDLF (>500mg) or LDHF (Low dose - High frequency). Where a 2nd dose was given the mean dose for the two approaches was 946mg for HDLF and 200mg for LDHF. The number with at least 1 additional infusion given by 3, 6 & 12 months were: for HDLF n=26, 56, & 113, & for LDHF n=24, 43 & 70.

Conclusion

These data suggest that the majority of patients with a Hb <100g/L who are treated with a 12mg/kg HDLF approach to IV iron will require repeated infusions within 12 months. The maximum permissible dose in a single infusion varies by product label. In this UK study the maximum single infusion dose of 20mg/kg meant that the mean cumulative iron requirements at 3 & 6 months could have been achieved in one infusion. At 12 months this threshold was exceeded. This gives an insight into how future approaches to iron dosing could be considered.

Funding

  • Commercial Support