Larger Doses of Maintenance IV Iron May Cut ESA Requirements
LAS VEGAS—Monthly requirements of erythropoiesis-stimulating agents (ESAs) to maintain target hemoglobin levels may be lower with larger doses of maintenance iron, investigators found.
Mahesh Krishnan, MD, MBA, MPH, and coworkers at DaVita Inc., in Denver evaluated intravenous (IV) iron sucrose dosing patterns in facilities with 10 or more dialysis patients. They categorized facilities to a dosing pattern if more than 40% of patients received the same dose: 25 mg once a week (234 facilities; 8.794 patients), 50 mg once a week (180 facilities; 7,060 patients), or 100 mg once a week (285 facilities; 9,938 patients).
The median ESA dose was significantly lower in facilities dosing 100 instead of 25 mg per week, Dr. Krishnan's team reported at the National Kidney Foundation's Spring Clinical Meetings. Compared with subjects treated with 25 mg per week, the median ESA dose (in units per month) was reduced significantly by 2,200 in subjects receiving 100 mg per week and nonsignificantly by 1,100 in those receiving 50 mg per week. Hemoglobin levels did not differ. Transferrin saturation and ferritin values increased slightly as weekly dose increased, but these changes were not statically or clinical significant, according to investigators.
Although IV iron initially was used as a bolus, the authors observed, more than half of the hemodialysis population receives IV iron for maintenance dosing.
“This retrospective analysis suggests that the use of maintenance iron regimens are an effective adjuvant to anemia management,” the authors concluded.