Effect of intravenous iron saccharate on the requirements of erythropoietin in hemodialysis patients.
We attempt in this study to evaluate the effect of intravenous iron saccharate (i.v. Sach) on the erythropoietin (EPO) requirements during the initial phase of replacement therapy with recombinant human erythropoietin (r-HuEPO) in adult chronic hemodialysis (HD) patients. We evaluated 96 study patients who completed 12 weeks of treatment with EPO. There were 69 (72%) males and 27 (28%) females with a mean age of 44 +/- 10 years (range 24 to74 years). The patients were initiated on EPO at 50 units/kg body weight subcutaneously post-dialysis two to three times weekly. Intravenous iron was administered to maintain the ferritin levels and transferrin saturation ratio within normal range. There were 36 (37.5%) patients who received i.v. Sach at doses of 100 mg at the end of dialysis two or three times per week during the whole study period (total dose 2400-3600 mg). Of the 96 study patients, 91 (94.8%) responded to the EPO. The mean hemoglobin (Hb) at entry to the study was 72 +/- 84 g/L (range 52-88 g/L). There was a significant increase of the mean Hb to 108 +/- 10 g/L (range 70-120 grams/L) at the end of the study (P< 0.0001). The mean total weekly dose per kg per patient per week of EPO was 149 +/- 11 (range 100-225) units/kg/week and decreased significantly to 141 +/- 24 units/kg/week at the end of the study (P< 0.0006). The study patients were stratified by the baseline ferritin and transferrin saturation (TSAT) into three sub-groups: group I: patients with TSAT < 0.2 and ferritin < 100 ng/ml; group II: patients with TSAT> 0.2 and ferritin < 100 ng/ml; group III: patients with TSAT> 0.2 and ferritin> 100 ng/ml. There were 19 patients in group I (13 received i.v. Sach), 26 in group II (16 received i.v. Sach) and 44 in group III (seven received i.v. Sach). There was a group of seven patients who had TSAT < 0.2 and ferritin> 100 ng/ml, however, none received i.v. Sach and they were not included in the stratification. There was no significant difference in the mean Hb between patients who received and those who did not receive i.v. Sach in the sub-groups studied. However, there was a significant decrease in the mean weekly dose of EPO in the patients who received i.v. Sach. We conclude that routine use of i.v. iron supplementation in chronic HD patients receiving recombinant EPO may be beneficial in the initial phase of treatment in attaining the target Hb with lower doses of EPO, regardless of the status of the iron indices.
Jeddah Kidney Center, Riyadh, Saudi Arabia.
Faissal Am
FA
Shaheen
Muhammad Ziad
MZ
Souqiyyeh
Nabeela
N
Akeel