Lower IV Iron Dosing in Anemic Dialysis Patients May Be More Effective

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To support ESA therapy, IV iron at doses below 300 mg/month may be most effective for the average hemodialysis patient, according to an observational study.
To support ESA therapy, IV iron at doses below 300 mg/month may be most effective for the average hemodialysis patient, according to an observational study.

Optimal intravenous (IV) iron dosing may be less than 300 mg/month for the average hemodialysis (HD) patient with anemia, a new study suggests.

Bruce M. Robinson, MD, MS, of Arbor Research Collaborative for Health in Ann Arbor, Michigan, and colleagues, examined IV iron doses and response to therapy for 9471 HD patients from 11 countries from the 2009–2011 Dialysis Outcomes and Practice Patterns Study (DOPPS). The team analyzed changes over 3 months in hemoglobin (Hgb), transferrin saturation (TSAT), ferritin, and erythropoiesis-stimulating agent (ESA) dose according to average IV iron dose in categories of 0, less than 300, and 300 or more mg/month.

As IV iron doses increased, Hgb, TSAT, and ferritin increased and ESA dose decreased across a range of starting Hgb, TSAT, and ferritin values, according to results published online in BMC Nephrology. In absolute terms, TSAT, ferritin, and ESA dose changes were minimized when IV iron was administered at less than 300 mg/month, including maintenance and replacement doses.

Researchers observed a median increase in Hbg of 0.18 g/dL for IV iron doses below 300 mg/month compared with no IV iron. Hbg rose an additional 0.13 g/dL with IV iron doses above 300 mg/month compared with IV iron doses below 300 mg/month, with minor variations according to starting values of Hgb, TSAT, and ferritin. Most patients had Hgb, TSAT, and ferritin levels within or near target ranges, the investigators noted.

The investigators noted that although residual confounding cannot be ruled out, their findings suggest that IV iron dosing of less than 300 mg/month, as commonly seen with maintenance dosing of 100–200 mg/month, may be a more effective approach to support Hgb than the higher IV iron doses (300-400 mg/month) often given in many European and North American HD clinics.

“Alongside studies supporting the safety of IV iron in 100-200 mg/month dose range, these findings help guide the rational dosing of IV iron in anemia management protocols for everyday hemodialysis practice,” the authors concluded in BMC Nephrology (2017;18:330).

The researchers cautioned that IV iron doses below 300 mg/month may not be optimal for all patients, such as those with Hgb far above or below target range or those hyporesponsive to ESA therapy.

Reference

Robinson BM, Larkina M, Bieber B, et al. Evaluating the effectiveness of IV iron dosing for anemia management in common clinical practice: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). BMC Nephrol 2017;18:330. doi: 10.1186/s12882-017-0745-9

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