Erythropoietin therapy in pre-dialysis patients with chronic renal failure: lack of need for parenteral iron.
BACKGROUND
During erythropoietin therapy, scant information exists regarding the optimal target percent saturation of transferrin (TSAT), ferritin and the mode and amount of iron supplementation in pre-dialysis patients with anemia due to chronic kidney disease (CKD).


OBJECTIVE
Pre-dialysis CKD patients may have different needs for iron supplementation than end-stage renal disease subjects during erythropoietin therapy.


METHODS
Retrospective analysis of pre-dialysis CKD subjects (n = 31) treated with erythropoietin at our institution.


RESULTS
In this population our results showed that target hematocrit (33-36%) was achievable with erythropoietin (mean subcutaneous dose 86 +/- 17 [SD] units/kg/week) without parenteral iron therapy. The hematocrit increased from a mean baseline value of 28.4 +/- 2.7 to 33.6 +/- 3.4% at time 1 (4-9 weeks, p < 0.0001), and to 37.7 +/- 4.5% at time 2 (10-20 weeks, p < 0.0001). The hemoglobin concentration increased from 9 +/- 0.9 g/dl at baseline to 10.7 +/- 1.1 g/dl at time 1 (p < 0.0001) and to 12 +/- 1.5 g/dl at time 2 (p < 0.0001). Subgroup analyses of patients prescribed <200 mg oral elemental iron per day (n = 10), those with TSAT <20% and/or ferritin <100 ng/ml (n = 19), and those prescribed erythropoietin <80 units/kg/week (n = 12), all showed a significant increase in hematocrit and hemoglobin.


CONCLUSIONS
Our data show that pre-dialysis CKD subjects respond adequately to erythropoietin at or lower than recommended erythropoietin doses without parenteral iron. This response extends even to subgroups with TSAT and/or ferritin levels deemed to indicate iron deficiency in CKD subjects, and may be due to lack of existence of functional iron deficiency in this group of patients.
Trivedi
Hariprasad S
HS
Nephrology Section, Harry S. Truman Memorial Veterans' Hospital, University of Missouri-Columbia, 800 Hospital Drive, Columbia, MO 65201, USA. trivedih@health.missouri.edu
Brooks
Blake J
BJ
D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005293:Ferritins / Q000032:analysis; D005296:Ferrous Compounds / Q000008:administration & dosage; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D011994:Recombinant Proteins; D012016:Reference Values; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D014168:Transferrin / Q000378:metabolism
D005296:Ferrous Compounds; D006454:Hemoglobins; D011994:Recombinant Proteins; D014168:Transferrin; D004921:Erythropoietin; C020748:ferrous sulfate; D005293:Ferritins