Intravenous iron dextran and erythropoietin use in pediatric hemodialysis patients

Abstract

Recombinant human erythropoietin (rHuEPO) is an effective treatment for the anemia of chronic renal failure. However, adequate availability of iron is necessary for an optimal response. We prospectively evaluated the effect of an intravenous iron protocol in a pediatric hemodialysis unit. Patients with either a serum ferritin less than 150 ng/ml or transferrin saturation (TSAT) less than 20% received intravenous iron dextran during ten consecutive dialysis sessions. The administration of rHuEPO was adjusted using a protocol designed to maintain patient hematocrit between 33% and 36%. Thirteen courses of intravenous iron were evaluated. Patients received 4 mg/kg of iron dextran (maximum of 100 mg) during each of ten consecutive dialysis sessions. In 12 cases there was a decrease in rHuEPO use 2 months after completing the course of intravenous iron. The mean rHuEPO dose decreased from 3,784 units to 2,115 units (P<0.005). Based on the criteria of response to intravenous iron, a percentage iron saturation of less than 20% had a high specificity for detecting iron deficiency. All patients who received a course of intravenous iron had a TSAT less than 20%. The measurement of serum ferritin was less useful in our patients.

Intravenous iron therapy in pediatric hemodialysis patients: a meta-analysis

“…Twelve (3.2%) of the identified studies met initial criteria for inclusion [4,7,11,12,13,14,15,16,17,18,19,20 ]. Two of these reports [19,20] were excluded because they were preliminary reports of a published study [11], as confirmed by the author (L. Greenbaum, personal communication, 24 April 2002). Another report was excluded because it did not contain specific numerical data for meta-analysis [15].…”

“…In three studies [7,11,12] we analyzed results from the entire data set that was published, in order to determine additional results or exclude non-qualifying subjects. Using statistical software (NCSS 2001, NCSS, Kaysville, Utah, USA), we recalculated the mean and standard deviation for included patients.…”

Tratamiento de la anemia con eritropoietina y hierro en Enfermedad Renal Crónica

“…En resumen, el uso rutinario de una gran cantidad de medicamentos vía oral, sumado a la falta de efectividad de las presentaciones orales de hierro y la actual disponibilidad de preparados intravenosos que se han asociado con una menor frecuencia de eventos adversos, ha determinado, en los últimos años, la realización de un mayor número de estudios respecto al uso de hierro intravenoso en población pediá-trica [49][50][51] .…”

“…En 2 estudios pediátricos que incluyeron a 33 pacientes en hemodiálisis no se reportaron reacciones adversas 49,60 . Eficacia: En uno de los estudios mencionados se analizó de forma prospectiva la respuesta a diferentes dosis de hierro sacarato en 14 pacientes pediátricos en hemodiálisis.…”

“…Otros autores recomiendan la administración de hierro intravenoso durante 8 a 10 sesiones consecutivas de HD en dosis que varían entre 1-4 mg/Kg/sesión, en aquellos pacientes con déficit de hierro 49,[59][60][61] . En nuestra experiencia de los últimos 5 años, en una población de 51 pacientes en DP, la aplicación de hierro sacarato (Venofer®) en dosis de 7 mg/kg/dosis con un máximo de 100 mg por semana por 3 semanas consecutivas, en pacientes con niveles de ferritina menor a 100 ng/ml, ha mostrado ser suficiente para recuperar los depósitos de fierro a un target de 100-500 ng/ml de ferritina sérica, un mes después de iniciado el tratamiento.…”