Correction of Uremic Iron Deficiency Anemia in Hemodialyzed Patients: A Prospective Study

Fudin, Roberto; Jaichenko, José; Shostak, Avshalom; Bennett, Michael T.; Gotloib, Lázaro

doi:10.1159/000045053

Cited by 96 publications

(80 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast, among patients receiving hemodialysis, three randomized clinical trials found no demonstrable efficacy for oral iron. [19][20][21] IV iron has better defined efficacy, but its use in NDD-CKD is limited by documented and perceived risks and the inconvenience of administering IV iron in the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Effects of Ferric Citrate in Patients with Nondialysis-Dependent CKD and Iron Deficiency Anemia

Fishbane

Block

Loram

et al. 2017

JASN

131

View full text Add to dashboard Cite

Iron deficiency anemia is common and consequential in nondialysis-dependent CKD (NDD-CKD). Efficacy and tolerability of conventional oral iron supplements are mixed; intravenous iron administration associates with finite but important risks. We conducted a randomized double-blind clinical trial in adults with NDD-CKD and iron deficiency anemia to compare the safety and efficacy of oral ferric citrate (n=117) and placebo (n=115). The primary end point was the proportion of patients who achieved a $1.0 g/dl increase in hemoglobin at any time during a 16-week randomized period. Patients who completed the 16-week period could also participate in an 8-week open-label extension period. Significantly more patients randomized to ferric citrate achieved the primary end point (61 [52.1%] versus 22 [19.1%] with placebo; P,0.001). All secondary end points reached statistical significance in the ferric citrate group, including the mean relative change in hemoglobin (0.84 g/dl; 95% confidence interval, 0.58 to 1.10 g/dl; P,0.001) and the proportion of patients who achieved a sustained increase in hemoglobin ($0.75 g/dl over any 4-week period during the randomized trial; 57 [48.7%] versus 17 [14.8%] with placebo; P,0.001). Rates of serious adverse events were similar in the ferric citrate (12.0%) and placebo groups (11.2%). Gastrointestinal disorders were the most common adverse events, with diarrhea reported in 24 (20.5%) and 19 (16.4%) and constipation in 22 (18.8%) and 15 (12.9%) patients treated with ferric citrate and placebo, respectively. Overall, in patients with NDD-CKD, we found oral ferric citrate to be a safe and efficacious treatment for iron deficiency anemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of Ferric Citrate in Patients with Nondialysis-Dependent CKD and Iron Deficiency Anemia

Fishbane

Block

Loram

et al. 2017

JASN

131

View full text Add to dashboard Cite

show abstract

“…[20][21][22][23] Historically, oral supplementation with ferrous salts in the absence of food failed to meet the erythropoietic demands of absolute and functional iron deficiencies in patients with ESRD, largely because of GI intolerance that limited dosing to approximately 200 mg elemental iron per day. [23][24][25] This inefficiency of oral iron supplementation led to the widespread use of iv iron in patients on dialysis, with the Dialysis Outcomes and Practice Patterns Study Practice Monitor reporting over 70% of patients on dialysis receiving iv iron at any given time in 2011. 26 Ferric citrate delivered much larger doses of elemental iron with food (up to 2520 mg/d) compared with previous oral preparations, and hence, it reduced or eliminated the need for iv iron.…”

Section: Discussionmentioning

confidence: 99%

Ferric Citrate Controls Phosphorus and Delivers Iron in Patients on Dialysis

Lewis

Sika

Koury

et al. 2015

Journal of the American Society of Nephrology

172

207

View full text Add to dashboard Cite

Patients on dialysis require phosphorus binders to prevent hyperphosphatemia and are iron deficient. We studied ferric citrate as a phosphorus binder and iron source. In this sequential, randomized trial, 441 subjects on dialysis were randomized to ferric citrate or active control in a 52-week active control period followed by a 4-week placebo control period, in which subjects on ferric citrate who completed the active control period were rerandomized to ferric citrate or placebo. The primary analysis compared the mean change in phosphorus between ferric citrate and placebo during the placebo control period. A sequential gatekeeping strategy controlled study-wise type 1 error for serum ferritin, transferrin saturation, and intravenous iron and erythropoietin-stimulating agent usage as prespecified secondary outcomes in the active control period. Ferric citrate controlled phosphorus compared with placebo, with a mean treatment difference of 22.260.2 mg/dl (mean6SEM) (P,0.001). Active control period phosphorus was similar between ferric citrate and active control, with comparable safety profiles. Subjects on ferric citrate achieved higher mean iron parameters (ferritin=8996488 ng/ml [mean6SD]; transferrin saturation=39%617%) versus subjects on active control (ferritin=6286367 ng/ml [mean6SD]; transferrin saturation=30%612%; P,0.001 for both). Subjects on ferric citrate received less intravenous elemental iron (median=12.95 mg/wk ferric citrate; 26.88 mg/wk active control; P,0.001) and less erythropoietin-stimulating agent (median epoetin-equivalent units per week: 5306 units/wk ferric citrate; 6951 units/wk active control; P=0.04). Hemoglobin levels were statistically higher on ferric citrate. Thus, ferric citrate is an efficacious and safe phosphate binder that increases iron stores and reduces intravenous iron and erythropoietin-stimulating agent use while maintaining hemoglobin.

show abstract

“…In ESAtreated patients, therefore, failure of an inexpensive adjuvant may increase the effective cost of anemia management. Although RCT have shown intravenous iron to be superior to oral iron in ESA-treated HD patients (12)(13)(14) and patients with CKD (15), RCT in PD patients are currently lacking. Our study provides needed information to guide the design, size, and duration of such a comparative trial.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intravenous Iron Sucrose in Peritoneal Dialysis Patients Who Receive Erythropoiesis-Stimulating Agents for Anemia

Singh

Reed

Noble

et al. 2006

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Although iron therapy is essential to optimize use of erythropoiesis-stimulating agents (ESA), randomized, controlled trials have heretofore been unavailable to evaluate reliably the efficacy of intravenous iron as an adjuvant to ESA treatment in peritoneal dialysis (PD) patients. In a multicenter trial, patients who had anemia, PD-dependent chronic kidney disease, stable ESA therapy, and a broad range of iron status (ferritin <500 ng/ml, transferrin saturation <25%) were randomly assigned to receive either 1 g of iron sucrose intravenously in three divided doses (300 mg over 1.5 h on days 1 and 15, 400 mg over 2.5 h on day 29) or no supplemental iron. No serious adverse drug events occurred after intravenous iron administration. The primary end point, peak hemoglobin increase, was higher (1.3 ؎ 1.1 versus 0.7 ؎ 1.1, mean ؎ SD; P ‫؍‬ 0.0028), and anemia intervention (transfusion, increase in ESA dose, or intravenous iron therapy not called for in protocol) occurred later (P ‫؍‬ 0.0137) and less often in intravenous iron-treated patients compared with untreated control subjects (one of 66 [1.3%] versus five of 30 [16.7%]). Among patients who did not require intervention, iron-treated patients showed a calculated net ESA dose decrease compared with untreated control subjects. Baseline iron status did not predict responsiveness to intravenous iron therapy. Intravenous iron sucrose is an effective adjunct to ESA therapy in anemic patients with PD-dependent chronic kidney disease and is administered safely as 300 mg over 1.5 h or 400 mg over 2.5 h. Evidence of iron deficiency at baseline is not required to demonstrate intravenous iron efficacy.

show abstract

Correction of Uremic Iron Deficiency Anemia in Hemodialyzed Patients: A Prospective Study

Cited by 96 publications

References 35 publications

Effects of Ferric Citrate in Patients with Nondialysis-Dependent CKD and Iron Deficiency Anemia

Effects of Ferric Citrate in Patients with Nondialysis-Dependent CKD and Iron Deficiency Anemia

Ferric Citrate Controls Phosphorus and Delivers Iron in Patients on Dialysis

Effect of Intravenous Iron Sucrose in Peritoneal Dialysis Patients Who Receive Erythropoiesis-Stimulating Agents for Anemia

Contact Info

Product

Resources

About