Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients

Abstract

Background. Haemodialysis patients need sustained treatment with intravenous iron because iron deficiency limits the efficacy of recombinant human epoetin therapy in these patients. However, the optimal intravenous iron maintenance dose has not been established yet. Methods. We performed a prospective multicentre clinical trial in iron-replete haemodialysis patients to evaluate the efficacy of weekly low-dose (50 mg) intravenous iron sucrose administration for 6 months to maintain the iron status, and to examine the effect on epoetin dosage needed to maintain stable haemoglobin values in these patients. Fifty patients were enrolled in this prospective, open-label, single arm, phase IV study. Results. Forty-two patients (84%) completed the study. After 6 months of intravenous iron sucrose treatment, the mean ferritin value showed a tendency to increase slightly from 405 AE 159 at baseline to 490 AE 275 mg/l at the end of the study, but iron, transferrin levels and transferrin saturation did not change. The haemoglobin level remained stable (12 AE 1.1 at baseline and 12.1 AE 1.5 g/dl at the end of the study). The mean dose of darbepoetin alfa could be reduced from 0.75 to 0.46 mg/kg/week; epoetin alfa was decreased from 101 to 74 IU/kg/week; and the mean dose of epoetin beta could be reduced from 148 to 131 IU/kg/week at the end of treatment. Conclusions. A regular 50 mg weekly dosing schedule of iron sucrose maintains stable iron stores and haemoglobin levels in haemodialysed patients and allows considerable dose reductions for epoetins. Low-dose intravenous iron therapy may represent an optimal approach to treat the continuous loss of iron in dialysis patients.

Efficacy and Safety of Intravenous Iron Therapy for Functional Iron Deficiency Anemia in Hemodialysis Patients: A Meta-Analysis

“…1) [7,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58], representing 24 single-arm or cohort studies and 10 parallel-arm RCT; 32 studies (94%) were published in full-text articles and 2 (6%) were scientific abstracts. The characteristics of the individual studies are displayed in table 1.…”

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

“…Low-dose intravenous iron therapy has advantages, such as the prevention of iron overload, maintenance of stable iron stores, effective utilization of administered iron for erythropoiesis [163], and suppression of variability of Hb level [164]. It has been reported that HD patients who are treated with intravenous iron at 50 mg/ week for 6 months maintained the target Hb levels with increasing ESA doses [165]. In contrast, another report showed that even low-dose (31.25 mg/week) intravenous iron for 12 months increased serum ferritin levels to 380 ng/mL [166], suggesting that the risk of iron overload should always be taken into account.…”

Low-Molecular-Weight Iron Dextran in the Management of Renal Anaemia in Patients on Haemodialysis – the IDIRA Study

“…Although parenteral iron preparations are widely used, only few published studies explore the effects of intravenous iron treatment in iron-repleted patients on HD (table 1) [9,10,28,29,30,31]. …”

“…The extent of reduction in erythropoietin dose was shown to be dependent on the type of erythropoietin and ranged from 11 to 27% [30]. …”