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Abstract: TH-PO669

Maintenance Intravenous Iron in Hemodialysis Patients to Minimize Erythropoietin Doses: A Double-Blinded, Randomized Controlled Trial

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Tantiyavarong, Pichaya, Thammasat University Faculty of Medicine, Khlong Nueng, Pathum Thani, Thailand
  • Anumas, Suthiya Anumas, Thammasat University, Pathum Thani, Pathum Thani, Thailand
  • Chatkrailert, Aphichat, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
Background

There is no standard regimen for maintenance iron supplementation in chronic hemodialysis patients. We investigated fixed-appropriate doses of intravenous (IV) iron protocols for maintaining hemoglobin levels and minimizing erythropoietic-stimulating agents (ESA).

Methods

A double-blinded, randomized controlled trial was conducted in hemodialysis patients who had ferritin levels of 200-700 ng/dl and transferrin saturation (TSAT) 20-40%. Patients were randomized to receive either 100-mg or 200-mg monthly IV iron. ESA was adjusted monthly to maintain Hb of 10-12 g/dl. The primary endpoint was ESA dose at 12 months. Key secondary endpoints were all-cause mortality, cardiovascular events, absolute iron deficiency anemia (IDA), blood transfusion, adverse events, and iron withholding rate.

Results

Of 79 eligible patients, 40 were in the 100-mg IV iron group and 39 in the 200-mg. Mean monthly ESA dose at month 12 was 35,706 ± 21,637 IU in the 100-mg IV iron group versus 26,382±14,983 IU in the 200-mg group (P = 0.03). Twelve patients (30%) in 100-mg group and four patients (10.5%) in 200-mg one had IDA (P = 0.05). Three patients in each group died (P = 0.9). There were no significant differences in hospitalization, venous access thrombosis, and infection rate in both groups, but these were slightly higher in the 200-mg cohort. The withholding rate was 25% and 64.1% (P = 0.03).

Conclusion

Monthly 200-mg IV iron doses were effective at minimizing ESA doses in hemodialysis patients but with a higher withholding rate. In high-ferritin patients, we suggest starting with 100-mg IV iron.

Mean monthly dosages of erythropoietin at month 0 (baseline), month 6, and month 12 (primary endpoint) between 100-mg and 200-mg intravenous iron groups