Lower IV Iron Dosing Regimen in Hemodialysis May Be Feasible
In a study, patients received half the amount of iron during the reduced dosing period: 126.6 vs 51.2 mg/month.
|The following article is part of conference coverage from Kidney Week 2018 in San Diego hosted by the American Society of Nephrology. Renal & Urology News staff will be reporting live on medical studies conducted by nephrologists and other specialists who are tops in their field in acute kidney injury, chronic kidney disease, dialysis, transplantation, and more. Check back for the latest news from Kidney Week 2018.|
SAN DIEGO—Lower doses of intravenous (IV) iron are as effective as the standard regimen for maintaining hemoglobin levels in patients on hemodialysis (HD), according to results of a small study presented at the American Society of Nephrology's Kidney Week 2018 conference.
Michael Yudd, MD, from the VA New Jersey Health Care System's East Orange campus, and colleagues initially treated 48 male veterans with standard dosing of IV sodium ferric gluconate to reach a hemoglobin (Hb) target of 10 to 11 g/dL for 6 months. The iron loading dose was 125 mg IV with each dialysis session x 8 doses, and the maintenance dose was 125mg IV weekly x 4 weeks. Iron dosing was halved for the next 6 months.
Dr Yudd's team reported finding no significant differences in the Hb levels, transferrin saturation (TSAT), and ferritin levels during the standard- and reduced-dosing periods. Mean Hb during the standard- and reduced-dosing periods was 10.46 and 10.41 g/dL, respectively, mean TSAT was 22.83% and 24.76%, and mean ferritin was 565 and 606 μg/L.
Up to a quarter of patients received IV iron during the standard (19.1%) and reduced (23.8%) dosing periods. Yet patients obtained less than half the amount of iron during the reduced dosing period: mean 126.6 vs 51.2 mg per month.
Erythropoietin dosage was similar during the both periods: 18,320 units per week for standard dosing and 14,928 units per week for reduced dosing. Nevertheless, more patients needed erythropoiesis-stimulating agents during reduced dosing: 32.8% vs 52.4%.
“There are several concerns of IV iron use, both short term and long term, such as worsening infection, iron overload, oxidative stress and atherosclerosis,” Dr Yudd told Renal & Urology News. “Implementation of a lower dosing IV iron regimen may mitigate potential adverse effects of iron supplementation without affecting iron stores and ESA dosing, while maintaining target Hb levels.”
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Thiruvarudsothy S, Srikanth T, Michaud J, and Yudd M. When it comes to intravenous iron, more or less, outcomes are same. Presented at the American Society of Nephrology's Kidney Week 2018 conference in San Diego, Oct. 23-28. Poster TH-PO241.