INTRAVENOUS IRON SUPPLEMENTATION FOR THE TREATMENT OF THE ANEMIA OF MODERATE TO SEVERE CHRONIC-RENAL-FAILURE PATIENTS NOT RECEIVING DIALYSIS

Iron deficiency may develop in hemodialysis patients, especially when erythropoietin is given, The role of iron deficiency in the anemia of predialysis chronic renal failure (CRF), however, is much less clear, We have intravenously (IV) administered iron as ferric saccharate in a total dose of 200 mg elemental iron monthly for 5 months to 33 CRF pa tients who remained anemic despite oral iron supplementation and who h ad no laboratory signs of iron overload, None was receiving erythropoi etin therapy, In 22 of the patients there was an increase in the hemat ocrit values by the end of the study, These patients were considered r esponders to intravenous iron (IV Fe) therapy, In 11 patients the iron administration was not associated with improvement of the anemia (non responders), Before onset of the IV Fe therapy there were no differenc es between the responders and nonresponders with regard to degree of a nemia, serum ferritin, iron saturation, renal function, or blood press ure, One additional patient was excluded from the study because of a m ild reaction during an IV test dose before the study, No worsening of kidney function and no other side effects were noted, In four patients (three responders and one nonresponder) the control of blood pressure necessitated antihypertensive drug therapy adjustment. In conclusion, IV Fe supplementation in two thirds of anemic CRF patients not receiv ing dialysis resulted in a significant improvement of the anemia, thus avoiding the necessity of erythropoietin or blood administration, Thi s could be achieved by increasing the plasma ferritin levels to 200 to 400 mu g/L and/or increasing the iron saturation to 25% to 35%, Intra venous ferric saccharate appears to be a safe and effective method of administering iron for the correction of anemia in CRF patients not re ceiving dialysis. (C) 1996 by the National Kidney Foundation, Inc.