No Reduction in Platelets Found With IV Iron Use in CKD

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New study shows that IV iron repletion with sodium ferric gluconate complex increased platelet count significantly at week 3 post-infusion and non-significantly at week 4.
New study shows that IV iron repletion with sodium ferric gluconate complex increased platelet count significantly at week 3 post-infusion and non-significantly at week 4.

AUSTIN, Texas—Intravenous iron repletion with sodium ferric gluconate complex (SFG) does not reduce platelet counts in patients with chronic kidney disease (CKD) and iron deficiency anemia, according to study findings presented at the National Kidney Foundation's 2018 Spring Clinical Meetings.

The finding contrasts with the results of previous studies demonstrating that IV iron repletion using iron dextran was associated with significant decreases in platelet counts.

The new study, led by Neville R. Dossabhoy, MD, Professor of Medicine at Louisiana State University School of Medicine and Chief of the Nephrology Section at the VA Medical Center in Shreveport, LA, examined platelet counts in approximately 100 patients with CKD-associated iron deficiency anemia who received a total of 362 doses of SFG over a 4-month study period. The investigators observed a significant rise in platelet counts at week 3 post-infusion, and a non-significant increase at week 4. The study also found a very weak correlation between baseline platelet counts and iron or transferrin saturation.

In a poster presentation, Dr Dossabhoy and his colleagues explained that iron deficiency may lead to reactive thrombocytosis, though the underlying causes are not fully known.

They pointed out that the previous DRIVE [Dialysis Patients' Response to IV Iron With Elevated Ferritin] trial showed that platelet counts decreased following IV administration of ferric gluconate, and a study by Anatole Besarab, MD, and colleagues showed that correction of iron deficiency with IV iron decreases platelet counts in patients with non-dialysis CKD.

These findings had “led to a hypothesis that iron deficiency could produce a relative thrombocytosis that may contribute to thrombotic events observed in clinical trials of erythropoiesis-stimulating agents (ESAs) in CKD patients,” Dr Dossabhoy's team wrote. “According to this view, iron deficiency is a risk factor for thrombocytosis which should, wherever possible, be avoided. Optimal co-administration of iron may therefore reduce the risk for ESA-driven cardiovascular events.”

However, given the findings of their latest study, “association of recently reported platelet reduction to postulated improvement in thrombotic outcomes needs additional prospective investigation.”

References

Watkins M, Pal S, Shirsat P, et al. Effect of intravenous iron repletion on platelet counts in patients with chronic kidney disease and iron deficiency anemia. Data presented at the National Kidney Foundation's 2018 Spring Clinical Meetings in Austin, Texas, April 10-14. Poster 153.

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