Refining the approach to IV iron use in hemodialysis patients: a post-DRIVE analysis.
Intravenous (IV) iron is a necessary component of the anemia management plan for the hemodialysis patient. Despite the demonstrated benefits of IV iron, questions remain as to the most effective strategies for using IV iron to maintain target hemoglobin (Hb) levels, ensure adequate iron supply, and optimize erythropoiesis-stimulating agent (ESA) therapy. Significant questions also surround the extent of the serum ferritin marker to reliably guide IV iron treatment decisions. The recent Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) and DRIVE-II studies showed that improvements in Hb levels, iron status, and ESA responsiveness can be achieved with a repletion course of IV iron in patients with serum ferritin levels up to 1200 ng/mL. These studies also demonstrated that higher serum ferritin levels are a poor predictor of positive response to IV iron. We sought to apply the lessons learned from the DRIVE studies in our hemodialysis clinic. We designed this retrospective study to determine if regular, low-dose IV iron administered to patients with serum ferritin levels up to 1200 ng/mL could improve measures of anemia and iron status while optimizing the use of IV iron and ESAs.
Sharma
Amit
A
Boise Kidney and Hypertension Institute, Meridian, Idaho, USA.
Vanderhalt
Kirsten
K
Ryan
Kenneth J
KJ
Sclafani
Jo
J
D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005290:Ferric Compounds / Q000008:administration & dosage*; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000032:analysis / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D006435:Renal Dialysis; D012189:Retrospective Studies; D017749:Total Quality Management; D016896:Treatment Outcome
D005290:Ferric Compounds; D006397:Hematinics; D006454:Hemoglobins; D005293:Ferritins; C035552:ferric gluconate