IV Iron Use for Anemia Rising, ESA Use Falling

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PHILADELPHIA—The use of intravenous (IV) iron for managing anemia in hemodialysis (HD) patients has increased steadily from 2002 to 2008, even after declines in the use of erythropoiesis stimulating agents (ESAs), as reported from data presented at Kidney Week 2011.

An analysis of U.S. Renal Data System data from approximately 250,000 HD patients per year for 2002-2008 revealed that the percentage of patients receiving IV iron increased from 63% in the first quarter of 2002 to 76% in the fourth quarter of 2008.

The mean quarterly iron dose rose from about 500 mg in 2002 to 660 mg in 2008, Janet K. Freburger, PhD, of the University of North Carolina in Chapel Hill, and colleagues reported in a poster presentation. The mean quarterly epoetin alfa (EPO) dose increased from nearly 65,000 IU/month in 2002 to just over 77,000 IU/month in the last quarter of 2006 and then declined to about 71,000 IU/month in 2008. Mean monthly hemoglobin levels trended with EPO dose increasing from 2002 to the first quarter of 2007 and then subsequently decreasing.

The investigators say they observed the same general patterns in iron doses, EPO doses, and hemoglobin levels across demographic and clinical subgroups, but noted important differences between subgroups in the amount of iron and EPO received, especially between white and black patients and between shorter and longer dialysis vintage groups. The mean quarterly iron and EPO dose for white patients ranged from 760-850 mg and 61,000-72,000 IU/month, respectively. Comparatively, doses administered among black patients were higher ranging from 785-890 mg for iron and from 70,000-85,000 IU/month for EPO. Iron dosing was highest and EPO dosing lowest in the shorter (one to two years) dialysis vintage groups.

“The temporal trends in EPO dosing,” Dr. Freburger told Renal & Urology News, “likely represent changes in response to the results of high target hemoglobin studies among pre-dialysis patients which resulted in changes to ESA labeling, clinical practice guidelines, and the Centers for Medicare and Medicaid Services reimbursement policy for ESA therapy. The reasons behind the growing use of iron are unclear and need further investigation especially in light of the declining hemoglobin levels in the later years of the study.”

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