Predialysis IV Iron Provides Superior Hemoglobin Control

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DENVER—Patients with end-stage renal disease who receive predialysis intravenous iron therapy are more likely to start hemodialysis with higher hemoglobin (Hb) levels and to achieve better Hb control better compared with patients treated with oral iron prior to dialysis initiation, French researchers reported.

This improved Hb control may translate into decreased use of erythrocyte-stimulating agents and iron during the first year after starting dialysis.

Jacques B. Rottembourg, MD, and his colleagues at Clinique Mont Louis in Paris, studied 60 patients who started hemodialysis (HD) in their HD unit and were followed for at least one year. During the pre-dialysis period, 15 (25%) of the 60 patients were treated with IV iron therapy and 45 (75%) received only oral iron therapy. During the year preceding dialysis initiation, the IV iron group received two to four 300 mg doses of IV iron. To maintain a target Hb level of 11.5 to 12 g/dL, clinicians administered IV darbepoetin alfa every two weeks and IV iron (iron sucrose) once a week during the mid-week dialysis session, based on Hb level and iron parameters. The IV iron dose ranged from 25 to 100 mg per week.

The mean Hb level at dialysis initiation in the pre-dialysis IV iron recipients was 11.1 g/dL, which was significantly higher than the level in oral IV iron recipients (10.4 g/dL). After starting HD, the IV iron group maintained significantly higher Hb levels, lower darbepoetin alfa use, and fewer IV iron doses during the first year. The mean Hb level was 12 g/dL in the IV iron group versus 11.1 g/dL in the oral iron recipients during the first three months and 12.5 and 11.6 g/dL, respectively, during the first 12 months. The mean dose of darbepoetin alfa (µg per injection) was 75.6 in the IV iron group compared with 107 in the oral iron group during the first three months, and 48 and 88, respectively, during the first 12 months. The darbepoetin alfa dose per patient was 752 µg and 529 µg in the IV and oral iron groups, respectively, during the first three months, and 1306 µg and 2368 µg, respectively, during the first 12 months. Mean iron use was 88 mg/week in the IV iron group compared with 90 mg/week in the oral iron group during the first three months and 83.5 and 87.9 mg/week, respectively, during the first 12 months.

Despite a need for prospective studies to confirm the team's preliminary data, the investigators concluded that their findings could impact the Medicare bundled payment rate for medications and the Medicare quality incentive payment program for iron and anemia management in HD patients.

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