Abstract

Purpose Dialysis patients may experience anemia due to functional iron deficiency, which occurs in the presence of sufficient iron stores but not enough circulating iron to provide Erythropoiesis-Stimulating Agents (ESAs) the ability to increase hematopoiesis. Current guidelines do not recommend routine administration of Intravenous (IV) iron when ferritin levels are greater than 500 ng/mL, however recent trials have shown patients receiving IV iron had further increases in Hemoglobin (Hgb) levels when ferritin was ≥ 500 ng/ml. The focus of this study is to evaluate the efficacy of IV iron therapy with epoetin alfa dosed on Hemoglobin levels for chronic Hemodialysis (HD) patients with elevated ferritin levels. Methods This retrospective study was conducted in patients who received chronic Hemodialysis (HD) from March 2001 to October 2009 with serum ferritin ≥ 500 ng/ml, baseline Hgb ≤ 12 g/dl, and prescribed at least one gram of ferric gluconate, iron sucrose, or iron dextran over one month. The primary objective was to evaluate the efficacy of IV iron therapies on hemodialysis patients with anemia and elevated ferritin levels receiving epoetin alfa as defined as a change in Hgb levels over a 90 day period. Secondary outcomes include changes in ferritin and iron saturation at baseline and at 90 days post IV iron therapy. Results Study patients receiving Intravenous (IV) iron had an increase in the average hemoglobin by 1.4 g/dL at 90 days of therapy (p < 0.05). Iron dextran, iron sucrose, and ferric gluconate increased the average hemoglobin by 1 g/dL, 1.4 g/dL, and 1.5 g/dL, respectively. After 90 days of therapy average serum ferritin levels decreased by 75.8 ng/mL (p > 0.05). Average weekly epoetin alfa doses at 90 days differed between iron products (iron dextran group 1,867 units, iron sucrose group 2,167 units and ferric gluconate group - 3,850 units) (p > 0.05). Conclusion At 90 days of therapy, there was a statistically significant increase in average hemoglobin despite elevated baseline ferritin and low transferrin saturation levels. Intravenous iron products can provide further increases in hemoglobin in anemic chronic hemodialysis patients.

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