Hemoglobin (Hb) variability is a risk factor for mortality and cardiovascular events in maintenance hemodialysis (HD) patients with anemia. Now a new study finds that intermittent administration of intravenous (IV) iron may lead to less hemoglobin variability than continuous administration.
Li Wan, MD, and Dongliang Zhang, MD, of Peking University International Hospital in China, tested both methods of IV iron administration in 34 patients. For continuous administration (CA), 100 mg of sucrose iron agents were infused during every HD session up to a total dose of 1000 mg. For intermittent administration (IA), the same amount of iron agents were given once weekly until the total dose of 1000 mg (approximately 3 months). Both groups of patients switched treatments after a 1-month washout period.
According to results published in International Urology and Nephrology, IA and CA resulted in similar iron increases. Serum ferritin levels in both groups increased significantly during follow-up. In group 1, it rose from 235.4 ng/mL at baseline to 362.4 ng/mL at month 3, then dipped to 315.0 ng/mL at month 7. In group 2, it rose from 250.5 ng/mL to 332.2 ng/mL to 347.4 ng/mL over the same time periods, respectively. Mean levels of Hb and doses of recombined human erythropoietin were similar between CA and IA. IA, however, was associated with less Hb variability, as measured by the standard deviation of Hb (Hb-SD) and coefficient variation of hemoglobin (Hb-CV). IA led to significantly less decline in Hb-SD (5.93 vs 7.36 g/L) and Hb-CV (0.054 vs 0.069) than CA.
“Iron supplementation by IA is better than CA,” according to Dr Wan and Dr Zhang. Larger studies are needed to confirm the results.
Wan L, Zhang D. Effect of frequency of intravenous iron administration on hemoglobin variability in maintenance hemodialysis patients. Intl Uro Nephrol. DOI: 10.1007/s11255-018-1916-8