Seligman PA, Schleicher R, Shapiro JR
Assessment of response to IV iron in hemodialysis patients
receiving recombinant erythropoietin
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1463 1996
Recently, the National Anemia Cooperative Project has confirmed the common
notion that iron deficiency frequently blunts the effectiveness of anemia
therapy in patients on hemodialysis. Intravenous iron therapy in particular
delivers iron directly to the reticuloendothelial system for rapid
processing
into biologically available iron. The purpose of this study was to assess
the
response to intravenous iron therapy in hemodialysis patients.
Intravenous iron dextran (1,000 mg) was administered to all hemodialysis
patients with serum ferritin < 200 OR transferrin saturation < 19%. These
criteria resulted in iv iron being given to 87% of study patients. Hct
increased significantly, and persisted higher for 4 months post- treatment.
The mean EPO dose was lowered significantly. A subanalysis evaluated factors
predicting why some patients responded well to iv iron, while others did
not.
Serum ferritin level was not predictive, and transferrin saturation only
slightly so. The best predictor was the starting reticulocyte count.
Generally, poor responders to iv iron given a second course tended to
respond
better with the additional iron treatment.
Comment: A study which confirms recent reports documenting: 1) Serum
ferritin
and TSAT are weak indicators of iron status in hemodialysis patients, 2) The
common treatment of 1,000 mg of iron dextran is frequently not enough, many
patients require greater than one course.
(Stephen Fishbane, M.D., Winthrop University Hospital, Mineola, NY)
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