THE EFFICACY OF IRON DEXTRAN FOR THE TREATMENT OF IRON-DEFICIENCY IN HEMODIALYSIS-PATIENTS

We prospectively evaluated the efficacy of intravenous iron dextran fo r the replacement of iron stores in iron deficient hemodialysis patien ts. Twenty-eight patients with serum ferritin <100 ng/ml were treated with 100 mg intravenous iron dextran for ten consecutive hemodialysis treatments. Therapy was considered successful if the serum ferritin re mained >100 ng/ml for 4 months after treatment. Mean hematocrit increa sed from 29.1 +/- 0.9% at baseline to 33.6 +/- 1.8% at ten weeks (p <0 .05). The mean erythropoietin dose decreased from 94.1 +/- 5.3 U/kg bo dy weight per treatment at baseline to 82.6 +/- 4.4 U/kg body weight p er treatment at 10 weeks (p <0.05). The mean serum ferritin at baselin e was 38.3 +/- 5.5 ng/ml, at 2 weeks 135.9 +/- 19.7 ng/ml, at 6 weeks 114.1 +/- 22.4 ng/ml, and 86.6 +/- 17.7 ng/ml at 10 weeks. The number of patients at the therapeutic target (serum ferritin >100 ng/ml) was 13 of 28 at 2 weeks after therapy, 9 of 28 at 6 weeks, and 8 of 28 at 10 weeks. The initial serum ferritin was the variable most predictive of successful therapy. None of 15 patients with baseline serum ferriti n less than 28 ng/ml had a serum ferritin >100 ng/ml at 4 months, comp ared with 8 of 13 (61%) with initial ferritins greater than or equal t o 28 ng/ml. Baseline hematocrit and transferrin saturation were not pr edictive of therapeutic success. In summary, this regimen for administ ration of intravenous iron dextran resulted in improved erythropoiesis , however, at study completion iron stores remained inadequate in the majority of patients. Baseline serum ferritin <28 ng/ml was highly pre dictive of patients who failed to reach the therapeutic target.