Is Giving Small Iron Doses Per Dialysis Session Better for Patients?

Patients provided small doses of intravenous iron per treatment achieved higher hemoglobin levels than patients receiving weekly iron.
Patients provided small doses of intravenous iron per treatment achieved higher hemoglobin levels than patients receiving weekly iron.

Administering intravenous (IV) iron in small doses per treatment (SIDT) may raise hemoglobin levels more successfully than weekly iron in hemodialysis patients, according to new research presented at the European Renal Association-European Dialysis and Transplant Association 53rd Congress in Vienna.

A team led by Joao Fazendeiro Matos, a researcher at Fresenius Medical Care Portugal in Porto, compared results from 8 clinics giving SIDT with 26 clinics administering weekly IV iron. Using database information, the investigators identified patients treated with online hemodiafiltration during 2013. Average age was 69 and 58.9% were men. For inclusion, patients had to be receiving hemodialysis for at least 3 months along with an erythropoiesis-stimulating agent (ESA) at least once a month and IV iron.

The researchers evaluated 665,712 treatments. Comparative analyses of the SIDT group (1385 patients) with the weekly iron group (3051 patients) revealed the following averages:

 

  •       ESA dose: 1.53 vs 1.58 µg/kg/month
  •       Iron dose: 2.81 vs 3.16 mg/kg/month
  •       Ferritin: 552 vs 573.94 ng/mL

The clinics that dispensed SIDT observed higher average hemoglobin values per unit of ESA than clinics giving weekly iron (7.32 g/dL vs 7.21 g/dL). SIDT clinics also saw significantly better average hemoglobin values per unit of iron (3.96 vs 3.45 g/dL).

Patients treated at SIDT clinics attained higher hemoglobin levels with less consumption of IV iron and ESA, the investigators concluded. “SIDT is more cost effective and may reduce the total amount of iron administered,” Fazendeiro Matos told Renal & Urology News. “It may protect patient safety by reducing iron toxicity, inflammation, and infection.”

Source

  1. Fazendeiro Matos J, Peralta R, Felix C, et al. Comparison of Patient Haemoglobin Outcomes With Weekly Iron Administration vs Per Session Iron Administration in Adult Haemodialysis Patients. Nephrol Dial Transplant (2016)31 (suppl 1): i274.doi: 10.1093/ndt/gfw174.02.
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