Erythropoietin Therapy in Pre-Dialysis Patients with Chronic Renal Failure: Lack of Need for Parenteral Iron

Abstract

Background: During erythropoietin therapy, scant information exists regarding the optimal target percent saturation of transferrin (TSAT), ferritin and the mode and amount of iron supplementation in pre-dialysis patients with anemia due to chronic kidney disease (CKD). Hypothesis: Pre-dialysis CKD patients may have different needs for iron supplementation than end-stage renal disease subjects during erythropoietin therapy. Methods: Retrospective analysis of pre-dialysis CKD subjects (n = 31) treated with erythropoietin at our institution. Results: In this population our results showed that target hematocrit (33–36%) was achievable with erythropoietin (mean subcutaneous dose 86 ± 17 [SD] units/kg/week) without parenteral iron therapy. The hematocrit increased from a mean baseline value of 28.4 ± 2.7 to 33.6 ± 3.4% at time 1 (4–9 weeks, p < 0.0001), and to 37.7 ± 4.5% at time 2 (10–20 weeks, p < 0.0001). The hemoglobin concentration increased from 9 ± 0.9 g/dl at baseline to 10.7 ± 1.1 g/dl at time 1 (p < 0.0001) and to 12 ± 1.5 g/dl at time 2 (p < 0.0001). Subgroup analyses of patients prescribed <200 mg oral elemental iron per day (n = 10), those with TSAT <20% and/or ferritin <100 ng/ml (n = 19), and those prescribed erythropoietin <80 units/kg/week (n = 12), all showed a significant increase in hematocrit and hemoglobin. Conclusions: Our data show that pre-dialysis CKD subjects respond adequately to erythropoietin at or lower than recommended erythropoietin doses without parenteral iron. This response extends even to subgroups with TSAT and/or ferritin levels deemed to indicate iron deficiency in CKD subjects, and may be due to lack of existence of functional iron deficiency in this group of patients.

Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Publisher: S. Karger AG

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date Subscription-year: 2003

Publication date (Print): April 2003

Publication date (Electronic): 17 January 2003

Volume: 23

Issue: 2

Pages: 78-85

Affiliations

^aNephrology Section, Harry S. Truman Memorial Veterans’ Hospital, and ^bPost-Doctoral fellow, Division of Nephrology, University of Missouri-Columbia, Columbia, Mo., USA

Article

Publisher ID: 68033 Other ID: Am J Nephrol 2003;23:78–85

DOI: 10.1159/000068033

PubMed ID: 12481145

Copyright statement: © 2003 S. Karger AG, Basel

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Page count

Figures: 3, Tables: 2, References: 34, Pages: 8

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Categories

Subject: Original Article: Patient-Oriented, Translational Research