1. The use of Ferinject® (ferric carboxymaltase) in the treatment of iron deficiency in patients with renal anaemia Dr D Farrugia Dr S Ramakrishna E Gibson Royal Shrewsbury Hospital, SaTH

2. Introduction Ferinject® has been used in our unit from March 2009. In this audit we will look at the patients who received Ferinject® in our unit from March 2009 to April 2011. In this period 105 patients have received Ferinject® in our unit.

3. Aims  Analyze demographics of the patients receiving Ferinject®  Analyze the pre and post ferritin and Hb levels  Analyze the proportion of patients receiving Ferinject® and EPO preparations  Analyze haemoglobin change in patients on EPO vs not on EPO at time of Ferinject® infusion  Follow up patients

4. Method A list of patients treated with IV Ferinject® since March 2009 had been recorded by our anaemia team. The results of each patient were looked up in renal plus and review results databases and recorded on an excel sheet.

5. Ferinject® Administration The dose of Ferinject required is calculated using the following formula:

6. Ferinject® Administration  In our unit Ferinject is given intravenously using an Alaris pump over 15-30 minutes.  The maximum dose of Ferinject is 15mg per kg body weight.  The maximum single dose of Ferinject is 1000mg per week.

7. Results  Demographics  Ferritin levels  EPO  Haemoglobin change in patients on EPO vs not on EPO at time of Ferinject® infusion  Follow-up of patients

8. Demographics Age: The average age is 73. Range was from 24 to 92 years.

9. Demographics

10. Demographics

11. Ferritin levels

12. 105 patients Ferritin 0-100: 94 patients 89.5% Ferritin 100-200: 9 patients 8.5% Ferritin >200: 1 patient 1% Ferritin unknown: 1 patient 1% Ferritin not checked: 1 patient Ferritin not checked: 1 patient Ferritin <100: 1 patient 11.1%/(0.9%) Ferritin <100: 6 patients 6.4%/(5.7%) Ferritin not processed: 1 patient 1.1%/(1%) Ferritin >200: 6 patients 66.7%/(5.7%) Ferritin >200: 71 patients 75.5%/(67.6%) Ferritin 100-200: 10 patients 10.6%/(9.5%) Ferritin not checked: 2 patients 22.2%/(1.9%) Ferritin not checked: 6 patients 6.4%/(5.7%) Post infusion Ferritin levels pre and post Ferinject ® Infusion

13. Ferritin levels

14.  In 6 patients ferritin levels were above 800ng/ml after 1 dose of Ferinject® infusion.  In 15 patients ferritin levels were above 500ng/ml after 1 dose of Ferinject® infusion.

15. Haemoglobin levels

16. *No change in Hb – Hb stayed within 1g/dL above or below the pre Ferinject® level

17. EPO 105 patients received Ferinject® 31 patients NOT had EPO 74 patients HAD EPO 40 patients had EPO PRIOR to Ferinject® 18 patients had EPO at the SAME* time as Ferinject® 16 patients had EPO AFTER Ferinject® *Patient being given simultaneously Ferinject® and EPO means that EPO was started up to 1 month before or after Ferinject® was given.

18. EPO

19. Haemoglobin change in patients not on EPO at time of Ferinject® group (n = 65 patients) (Patients not on EPO include patients who never received EPO, were not on EPO at time of Ferinject® infusion or started EPO at the same tine as Ferinject® infusion)

20. Haemoglobin change in patients not on EPO at time of Ferinject® group (n = 65 patients) (Patients not on EPO include patients who never received EPO, were not on EPO at time of Ferinject® infusion or started EPO at the same tine as Ferinject® infusion)

21. Haemoglobin change in patients on EPO at time of Ferinject® group (n = 40 patients)

23. Follow-up Further doses of Ferinject®  12 patients had further doses of Ferinject® (and another one possibly had further doses prescribed by the haematologists)  Of these patients who had repeat doses 9 patients (75%) had 1 further dose, 2* patients (16.7%) had 2 further doses, 1 (8.3%) patient had 4 further doses *1 of the patient who had 2 further doses was actively bleeding at the time.

24. Follow-up If the patient who was actively bleeding is excluded as it is likely to give skewed data, the average interval between Ferinject doses was 7.33 months

25. Follow-up of patients who received Ferinject® 96 patients PREDIALYSIS/ CONSERVATIVE 3 patients TRANSPLANT 1 patient changed to HAEMODIALYSIS 1 patient had 1 FURTHER DOSE 1 patient DIED 11 (+1) patients FURTHER DOSE 6 patients DIED 2 patients PERITONEAL DIALYSIS 9 patients HAEMODIALYSIS 2 patients DIED 1 patient HAEMODIALYSIS 1 patient DIED 2 patients HAEMODIALYSIS 105 patients 6 patients PERITONEAL DIALYSIS

26. Thank-you Any questions?