[Clinical and economic significance of iron replacement in anemia treated with recombinant human erythropoietin in patients on hemodialysis].
BACKGROUND
Anaemia is a common phenomenon encountered in patients on hemodialysis. Although treatment with rHuEPO therapy is effective, it may fail even at high doses. As rHuEPO efficacy depends on the bioavailability of iron, we monitored the effect of consistent iron supplementation on hematocrit levels and rHuEPO dosage.


RESULTS
24 patients of our outpatient dialysis centre were included in this study. The mean age was 59 years. The age group over 60 included 14 patients. The mean duration of dialysis treatment was 23.8 months. The patients were followed for 6 months according to the NKF-DOQI (National Kidney Foundation Dialysis Outcomes Quality Initiative) recommendations for the treatment of anaemia. Following values were examined monthly: hematocrit, transferin saturation (TSAT) and ferritin. Iron and rHuEPO dosage was adjusted accordingly. Genetic tests for haemochromatosis were conducted in 4 patients with the highest value of TSAT and ferritin. TSAT increased from a mean of 15.9% to 35.9% (p < 0.001). In 23 patients (96%) TSAT levels were within the recommended range after the treatment. Hematocrit increased from 27.7% to 35.7% (p < 0.001). The recommended value of 33% was achieved in 18 patients (75%). The weekly dose of eHuEPO fell from 3958 IU (International Unit) to 2042 IU (p < 0.001), i.e. 1857 IU of rHuEPO were saved per week, per patient. The average dose of iron administered was 157 mg per week. The average level of ferritin rose from 457 micrograms/k to 1387 micrograms/l (p < 0.001). All results were comparable, even in the group of the senior's selected cases. Genetic testing for haemochromatosis showed mutation H63D in heterozygous state of HFE gene in 2 of 4 patients with the highest value of TSAT and ferritin. Sufficient iron supplementation leads to a significant rise in hematocrit and a concomitant decrease of required rHuEPO doses. TSAT, and not ferritin, is a good marker of iron bioavailability.


CONCLUSIONS
The financial savings due to decreased rHuEPO requirements are 20 times higher than the costs related to iron supplementation, calculated in relation to prices valid for the Czech Republic in 1999. Cause and effect of increased level of ferritin should be carefully studied.
Vanková
S
S
I, interní klinika 3. LF UK a FNKV, Praha. svetla.van@post.CZ
Safárová
R
R
Horácková
M
M
Herink
J
J
Rychlík
I
I
Bahbouh
R
R
Půtová
I
I
D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000191:economics / Q000209:etiology / Q000628:therapy*; D017046:Cost Savings; D018153:Czech Republic; D004921:Erythropoietin / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006400:Hematocrit; D006801:Humans; D007501:Iron / Q000097:blood / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000191:economics / Q000627:therapeutic use*; D011134:Polysaccharides / Q000191:economics / Q000627:therapeutic use*; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects; D014168:Transferrin / Q000032:analysis
D009942:Organometallic Compounds; D011134:Polysaccharides; D011994:Recombinant Proteins; D014168:Transferrin; C009766:ferrum lek; D004921:Erythropoietin; D007501:Iron