Intravenous iron for CAPD populations: proactive or reactive strategies?
BACKGROUND
The European best practice guideline [Nephrol Dial Transplant 1999; 14 (Suppl 5)] (5A) for the management of anaemia suggests that > 85% of the CAPD population should have a haemoglobin level of > 11.0 g/dl.


METHODS
We developed and implemented an outpatient-based protocol for intravenous iron sucrose (IV Fe) and erythropoietin (Epo) in CAPD patients showing iron deficiency despite oral iron therapy. We managed a total of 103 patients over 13 months of study. All CAPD patients were included, regardless of co-morbidity. Treatment developed in two phases: in phase 1 (reactive) (months 1-8), patients with markers of iron deficiency (ferritin < 100 ng/ml or ferritin 100-500 and percentage hypochromic red cells (%HRC) > or =5) were converted from oral iron to IV Fe (300 mg) and reviewed after 4-8 weeks according to haemoglobin (Hb). In phase 2 (proactive) (months 9-13), the criteria for iron therapy were extended: ferritin < 150 ng/ml or ferritin 150-500 and %HRC > or = 2. Patients then received IV Fe (200 mg) and were reviewed after 4 weeks according to Hb.


RESULTS
The median haemoglobin increased from 11.0 (Inter quartile range, IQR, 10.1-12.6) g/dl to 11.7 (11.0-12.7) g/dl (P = 0.06). The proportion of patients with absolute iron deficiency (ferritin < 100 ng/ml) decreased from 24 to 2%. The percentage of hypochromic red cells (%HRC) decreased from 4 (2-7) to 1 (1-4) (P < 0.01).


CONCLUSIONS
An integrated Epo and IV Fe policy increased the number of patients reaching the European guideline from 50 to 75% with no increase in the population median Epo requirements (42 (IQR, 25-95) IU/kg/week vs 45 (27-101) (P = NS)). This study demonstrates the benefit of early (proactive) intervention in achieving population compliance within current guidelines for renal anaemia.
Richardson
D
D
Department of Renal Medicine, St James's University Hospital, Beckett St, Leeds, UK.
Bartlett
C
C
Jolly
H
H
Will
E J
EJ
D000747:Anemia, Hypochromic / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D002985:Clinical Protocols; D004921:Erythropoietin / Q000008:administration & dosage; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007275:Injections, Intravenous; D007501:Iron / Q000008:administration & dosage*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D011994:Recombinant Proteins; D013997:Time Factors
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron