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Effective utilization of erythropoietin with intravenous iron therapy
Author(s) -
Bhandari S.,
Brownjohn A.,
Turney J.
Publication year - 1998
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1046/j.1365-2710.1998.00147.x
Subject(s) - medicine , erythropoietin , transferrin saturation , ferritin , iron deficiency , anemia , adverse effect , erythropoiesis , dialysis , serum iron , parathyroid hormone , intravenous iron , surgery , gastroenterology , calcium
Iron replacement therapy reduces the demand for erythropoietin (EPO) in some dialysis patients. It has been postulated that iron supply to the bone marrow is a rate‐limiting step in the process of erythropoiesis under erythropoietin stimulation. Methods: We evaluated the economic benefit of intravenous iron therapy for this purpose in a prospective, non‐blinded study of 22 haemodialysis patients, 16 male, six female, mean age 62 years (range 24–80 years). All patients had a serum ferritin (SF) of 460 μg/L, despite oral iron therapy. Patients with high aluminium and/or parathyroid hormone (PTH) levels, underlying bleeding/haematological disorders or active inflammatory diseases were excluded. Patients were established on subcutaneous EPO and given intravenous iron over seven consecutive dialysis sessions (total dose 1050 mg) and supplemental monthly doses with regular monitoring for 4 months. Results: The median EPO dose was 4000 units/week (mean 6050 units/week) pre‐treatment and 2000 units/week (mean 3700 units) at 6 weeks post intravenous iron therapy (P=0·03). No serious adverse events occurred in the 154 treatment sessions of intravenous iron. Mean haemoglobin (Hb) level remained constant at 6 and 12 weeks (P =0·087). Serum ferritin levels ( P< 0·0001) rose significantly, while a reduction in transferrin saturation (TS) became significant at the end of the study (P =0·0047). The use of intravenous iron allowed a substantial monthly cost saving per patient in our unit. Conclusion: Intravenous iron therapy is a safe and cost‐effective method for maintaining or improving Hb levels with a more effective utilization of EPO in patients with low SF levels despite oral iron therapy.