IV Iron, Erythropoietin Equally Effective for Anemia in HD Patients

NEW ORLEANS—Intravenous (IV) iron and erythropoietin are equally effective for treating anemia in most hemodialysis patients, British researchers concluded in a poster presentation at the American Society of Nephrology’s Kidney Week 2017 meeting.

In a randomized controlled trial, Damien Ashby, PhD, and colleagues at Imperial College Renal and Transplant Centre in London studied 194 stable HD patients who became moderately anemic (hemoglobin level 90-104 g/L). They randomly assigned patients to treatment with either IV iron (1 g divided over 5 consecutive sessions [IVFE group]) or increased erythropoietin (starting 3000 units per week or median increase of 50% [EPO group]). They followed up patients for as long as 18 months.

Dr Ashby’s team observed a positive hemoglobin response (an increase of at least 5 g/L by 2 months) in 54 (71.1%) of 76 IVFE patients and 62 (73.8%) of 84 EPO patients, a between-group difference that was not statistically significant.

In the IVFE group, compared with non-responders, lower hepcidin levels and lower mean cell volume predicted a positive hemoglobin response. In the EPO-treated patients, only low C-reactive protein predicted a positive hemoglobin response.

Ferritin levels did not predict hemoglobin response in either group.

Reference

Hildebrand S, Duncan ND, Tam FWK, Ashby D. Randomised controlled trial of intravenous iron versus increased erythropoietin in haemodialysis anaemia. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Abstract SA-PO824.