EFFECT OF INTRAVENOUS NA-FE-GLUCONATE IN HEMODIALYSIS-PATIENTS TREATING WITH RHUEPO

The optimal haemopoietic response to recombinant human erytropoietin ( rHu-EPO) requires an adequate supply of iron. Oral iron is a safe form of substitution but frequently it does not suffice and intravenous ir on is necessary. The objective of our study was to evaluate the effica cy and safety of intravenous iron, given as sodium ferric gluconate (N a-Fe-G), for maintenance iron therapy in hemodialysis patients undergo ing rHuEPO treatment. Patients and methods: Eighty-five stable hemodia lysis patients with initial serum ferritin < 200 ng/ml and receiving r HuEPO were treated with intravenous Na-Fe-G during three months. Patie nts with ferritin < 50 ng/ml received 187 mg weekly, divided in to 3 i ntravenous doses, patients with ferritin > 50 received 62.5 mg weekly in one dose. Patients were stratified in 3 groups according to serum f erritin baseline values. Group I: ferritin < 50 ng/ml (19 patients), G roup II: ferritin 50-100 ng/ml (25 patients) and Group III: ferritin > 100 ng/ml (41 patient). rHuEPO dose was adjusted to maintain hemoglob in within 9.5-10 g/dl. At baseline hemoglobin, Hct, ferritin and trans ferrin saturation were measured and were repeated 2 and 3 months after . Results: A significant decrease of mean weekly rHuePO dose became ob vious after I month in all groups. At study completion it had fallen b y 60.2% (Group I), 38.4% (Group II) and 27.0% (Group III), and 19 pati ents: 7 (26%) of Group I, 7 (28%) of Group II and 5 (12%) of Group III maintained hemoglobin > 9.5 g/dl without the use of rHuEPO. Target he moglobin was maintained in all groups. Hemoglobin and Hct increased fr om baseline in Group I and Group III while Group II reimaned stable. G roup I had the highest final hemoglobin and maximal decrease of rHuEPO . There were no adverse effects. Conclusions: Intravenous Na-Fe-G: 1) Is an effective and safe way of administering iron. 2) Optimises haemo poietic response to rHuEPO allowing the reduction of rHuEPO doses requ ired to maintain target hemoglobin in hemodialysis patients with serum ferritin < 200 ng/ml. 3) Causes the greatest response in patients wit h initial ferritin > 50 ng/ml.