title: Iron repletion is associated with reduction in platelet counts in non-dialysis chronic kidney disease patients independent of erythropoiesis-stimulating agent use: a retrospective cohort study.
abstract: BACKGROUND
  Iron deficiency is common in non-dialysis chronic kidney disease (ND-CKD) patients and, on occasion, requires parenteral iron therapy. We investigated the effect of intravenous iron repletion on platelet counts in ND-CKD patients with and without concomitant darbepoetin administration.
  
  
  METHODS
  We conducted a retrospective analysis of ND-CKD patients with iron deficiency anemia treated with low molecular weight iron dextran (LMWID) between 2005 and 2009 at our CKD clinic. The primary end-point was change in platelet count 60 days post infusion of LMWID in those with and without concomitant darbepoetin administration. Secondary end-points were the correlations between changes in platelet count and iron indices.
  
  
  RESULTS
  A total of 108 patients met inclusion and exclusion criteria. The decrease in platelet counts in response to iron repletion was statistically significant (305.72 ± 108.86 vs 255.58 ± 78.97, P = < .0001). The decrease in platelet count was independent of concomitant darbepoetin use. Bivariate regression analysis between baseline platelet count and transferrin saturation by iron (TSAT) showed a negative association (βTSAT = -5.82, P = .0007) and moderate correlation (R = 0.32). Following iron treatment, the within individual changes in platelet count in 60 days were not related to changes in TSAT (βΔTSAT = -0.41, P = .399) and demonstrated a poor correlation (R = 0.10).
  
  
  CONCLUSIONS
  Parenteral iron treatment by LMWID is associated with reduction in platelet counts in iron deficient anemic ND-CKD patients. However, ESA use in the majority of patients prior to intravenous iron administration could have altered platelet production through bone marrow competition.
authors.affiliation: Division of Nephrology and Hypertension, Henry Ford Hospital, 2799 W, Grand Blvd, CFP-514, Detroit, MI, USA. lyessay1@hfhs.org.
authors.forename: Lenar
authors.initials: L
authors.lastname: Yessayan
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.forename: Gary
authors.initials: G
authors.lastname: Zasuwa
authors.forename: Stan
authors.initials: S
authors.lastname: Frinak
authors.forename: Anatole
authors.initials: A
authors.lastname: Besarab
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D004920:Erythropoiesis / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000379:methods; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D006397:Hematinics; D007501:Iron