Effectiveness of oral iron to manage anemia in long-term hemodialysis patients with the use of ultrapure dialysate

Abstract

Abstract. the aim of this study was to evaluate the effectiveness of oral iron to manage anemia in long-term hemodialysis (hd) patients using ultrapure dialysate. this study was prospectively conducted on 23 patients (11 males and 12 females; median age 60 years, range 35-81) who underwent hd in our hospital from march to September 2007. the patients were randomly assigned to two treatment groups. The first group of 11 patients received ferrous fumarate 305 mg per oral tablet once a day, while the second group of 12 patients received infusions of 50 mg iron in a 0.9% sodium chloride solution. at the end of the 6-month treatment, patients receiving oral iron and intravenous iron had a significant increase in transferrin saturation from baseline (20.1±8.9 to 29.7±7.2; p=0.011 and 17.4±6.1 to 33.7±8.6; p=0.0001, respectively) and ferritin (32.6±15.4 to 115.4±28.2; p=0.0001 and 57.8±26.7 to 183.5±47.5; p=0.0002, respectively). in both groups, hemoglobin, hematocrit and dry weight were increased, but did not reach statistical significance. Moreover, both groups showed a significant reduction in the mean weekly erythropoietin dose from baseline (5,590.9±1,513.6 to 3,727.3±1,618.1; p=0.011 and 6,775.8±2,292.2 to 4,375.0±2,473.7; p=0.027, respectively). Oral iron is indeed as effective as intravenous iron in managing anemia in hd patients using ultrapure dialysate.

Intravenous Versus Oral Iron Supplementation for the Treatment of Anemia in CKD: An Updated Systematic Review and Meta-analysis

“…[29][30][31][32][33][34][36][37][38][39] Hb concentration change from baseline was increased in the IV arm (mean difference, 0.33 [95% CI, 20.11 to 0.76] g/dL; 3 trials; 319 patients). 34, 35,37 Two trials including 164 patients reported the number of patients who reached Hb levels .…”

“…23,25,28 Patients who received IV iron replacement had a significantly higher risk for documented hypotension (RR, 3.71; 95% CI, 1.74-7.94; 14 trials) 18-21,23-27,29,34,36,37,39 and a significantly lower risk for GI adverse events (RR, 0.43; 95% CI, 0.28-0.67; 14 trials). [18][19][20][21][23][24][25][26][27]29,30,34,36,38 Number of hospitalizations was reported in only one trial with few events and no significant difference between study groups. 30 Number of cardiovascular events was reported in only one trial that included few participants.…”

“…[29][30][31][32][33][34][36][37][38] There was no statistically significant difference in TSATs between the 2 groups.…”

“…16,[19][20][21][22][23][25][26][27][28]30,33,34,[37][38][39] There was no difference between study groups in rates of any adverse effects (RR, 0.83; 95% CI, 0.66-1.03), 17-21,23,25,27,29-31, Fig 5), 17,18,20,23,[25][26][27][28][29][30]33,34,[36][37][38][39] or adverse effects requiring treatment discontinuation (RR, 0.62; 95% CI, 0.32-1.19). [16][17][18][19][21][22][23][24][25]27,[29][30][31]34,[36][37][38][39] Risk for infection was also similar...…”

Hepcidin-25, Mean Corpuscular Volume, and Ferritin as Predictors of Response to Oral Iron Supplementation in Hemodialysis Patients

“…In addition, approximately 20% of HD patients with IDA have experienced benefits from OIT [ 2 ]. Recent studies have shown the benefit of OIT to be equivalent to intravenous iron therapy in HD patients with IDA [ 4 , 5 ]. OIT is inexpensive and associated with less serious adverse effects than intravenous iron therapy [ 1 ].…”