In patients receiving hemodialysis, a monthly intravenous iron dose of 200 mg maintains hemoglobin levels within target range while minimizing use of erythropoiesis-stimulating agents (ESA), according to data presented at Kidney Week 2022, the annual meeting of the American Society of Nephrology, in Orlando, Florida.

In a double-blinded trial, investigators randomly assigned 40 patients to 100 mg IV iron per month and 39 patients to 200 mg IV iron per month. Patients had baseline ferritin levels of 200-700 ng/dL and transferrin saturation (TSAT) of 20%-40%. ESA dose was adjusted monthly to maintain hemoglobin levels of 10-12 g/dL.

By 12 months, the 100-mg group was receiving a higher mean monthly ESA dose compared with the 200-mg iron group (35,706 vs 26,382 IU), Pichaya Tantiyavarong, MD, DSc, of Thammasat University Faculty of Medicine in Khlong Nueng, Pathum Thani, Thailand reported on behalf of his team. The iron withholding rate, however, was significantly higher for the 200-mg group (64.1% vs 25%). Iron-deficiency anemia developed in a significantly greater proportion of the 100-mg than 200-mg group (30% vs 10.5%), he reported.

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Rates of hospitalization, venous access thrombosis, and infection did not differ significantly between groups. Three patients in each group died.

Monthly 200-mg IV iron doses were effective at minimizing ESA doses in hemodialysis patients but with a higher iron withholding rate, Dr Tantiyavarong’s team concluded. They suggested that patients with high ferritin should start with 100-mg IV iron.


Tantiyavarong P, Anumas SA, Chatkrailert A. Maintenance intravenous iron in hemodialysis patients to minimize erythropoietin doses: A double-blinded, randomized controlled trial. Presented at: Kidney Week; November 3-6, 2022. Abstract TH-PO669.