title: [Optimizing iron therapy in hemodialysis: a prospective long term clinical study].
abstract: The usefulness of intravenous iron therapy in hemodialysis is evidence-based. However, controversy still arises about the most suitable iron marker to optimize this treatment in the long term. We aimed to determine the most suitable marker with a prospective, cohort study, designed to comprise a basal period (BP) and two consecutive experimental periods (PI, PII). Low molecular weight iron dextran was infused at 100, 150 and 200 mg/month respectively, on a biweekly basis, during 6 months. At the end of each period, the following were determined: transferrin saturation (TSAT), ferritin (FERR), percentage of hypochromic eritrocytes (HYPO) and haemoglobin content in reticulocytes (HCr). During the study, albumin increased significantly, whereas no significant changes in hemoglobin, EPO doses and C-reactive protein were observed. Changes in HYPO and FERR were unspecific. Only TSAT (from 21.4 ± 6 in PB to 34 ± 7.1% in PII, p < 0.01) and HCr (from 27.5 ± 1.3 in PB to 29.3 ± 1.7 pg in PII, P < 0.05 ) responded specifically to changes in Fe doses, but change of TSAT was 65% (CI 95% 22), whereas change of HCr was just 6% (CI 95% 2.3; p = 0.0002). The difference was observed in all patients. Results suggest that 200 mg/FeIV/month is effective and that, of the markers tested in this study, TSAT would be the most suitable one to the practicing nephrologist to optimize intravenous iron in the long term.
authors.affiliation: Centro de Diálisis Madariaga, Centro de Diálisis Gesell, Buenos Aires. siga@telpin.com.ar
authors.forename: Esteban
authors.initials: E
authors.lastname: Siga
authors.forename: David
authors.initials: D
authors.lastname: Aiziczon
authors.forename: Guillermo
authors.initials: G
authors.lastname: Díaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004812:Epidemiologic Methods; D005260:Female; D006397:Hematinics / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007505:Iron-Dextran Complex / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D014168:Transferrin / Q000032:analysis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006397:Hematinics; D014168:Transferrin; D007505:Iron-Dextran Complex