1. Medical Directorate, National Kidney Foundation, Singapore
Efficacy and safety of low dose intravenous iron in ESRD patients on hemodialysis.
Sreekrishna V MD, Balasubramanian S MD, Prabhakar KS MD* and Nandakumar M MD,MRCP,FAMS.
Medical Directorate, National Kidney Foundation, Singapore
Introduction:
Conventional protocols for replacement of intravenous iron (i.v.iron) are effective but iron overload remains a major concern. We studied the outcome of short course of low dose intravenous iron in patients on hemodialysis.
Methods:
We retrospectively evaluated the data of patients on hemodialysis who received I.V. iron replacement during year Patients who were considered to have iron deficiency (both absolute and functional) received 500 mg of I.V. iron (Iron Sucrose 100 mg per dose) over 2 to 5 weeks duration. Complete iron profile including serum iron, ferritin and transferrin saturation (TS%) was obtained before and 2 months after completion of the therapy. Hemoglobin(Hb) was monitored 2 weekly. Any change of erythropoietin dose was noted at the end of 4 and 8 weeks
Results:
Sixty five patients completed the 5-course therapy. Absolute iron deficiency (ferritin <100ng/ml and TS% <20) was noted in 10%, whereas, variable numbers had some form of iron deficiency with TS%  20 in 40% and ferritin <100 ng/ml in 35%. The hemoglobin and iron profile before and after treatment was given in table below
N( 65)
Pre treatment
One month after i.v iron
Two months after i.v iron
P value
Hemoglobin(Hb)
9.6  1.2
10.3  1.4
10.6  1.2
P<0.001
Serum Iron
58.7  25.1
71.5  27.1
P=0.001
Transferrin Saturation
26.8  12.9
34.5  15.2
Ferritin
211.8  167.4
357.1  228.1
Only 3 (4.5%) patients have serum ferritin more than 800 ng/ml at the end of the study. However, there was no significant change in the dose of erythropoietin required.
Conclusion
Our study indicates that short course of relatively low dose of intravenous iron is effective in the management of anemia in patients on hemodialysis without producing iron overload. Such therapy may be safe and cost effective when given intermittently rather than high dose replacement followed by maintenance.