Supplemental iron via dialysate: a novel mode of delivery for hemodialysis patients

Gupta et al. describe a novel strategy for iron administration to hemodialysis patients, giving ferric pyrophosphate citrate via the dialysate. PRIME, a randomized controlled study comparing this technology against placebo, shows a 35% reduction in prescribed erythropoiesis-stimulating agent dose. The findings may be explained in part by a restrictive protocol for intravenous iron administration in the placebo group, producing lower ferritin levels. There were no obvious safety concerns. The general applicability of this technology, and its cost-effectiveness, are unclear at the present time.