INTRAVENOUS-INFUSION OF TOTAL-DOSE IRON IS SUPERIOR TO ORAL IRON IN TREATMENT OF ANEMIA IN PERITONEAL-DIALYSIS PATIENTS - A SINGLE-CENTER COMPARATIVE-STUDY

In the treatment of anemia of chronic renal failure, the most common c ause of recombinant human erythropoietin (rhEPO) resistance is iron de ficiency. In peritoneal dialysis (PD) patients, oral iron therapy is a n accepted and convenient method of iron supplementation. The effectiv eness of oral iron, however, is limited by many factors, including gas trointestinal side effects and poor gastric absorption. This study pro spectively compared the efficacy of single intravenous infusion of tot al dose iron (ITDI group) given in an outpatient setting with oral iro n (oral group) for the treatment of anemia in PD patients. Twenty-five adult stable PD patients with baseline hematocrit 25 to 35% were ente red into the study. Thirteen patients with serum transferrin saturatio n (TSAT) <25% received ITDI, and 12 patients with TSAT between 25 and 35% received oral iron. One patient in the oral group received emergen t blood transfusion and was excluded from analysis. Hematocrit and iro n indices were measured at monthly intervals. Doses of rhEPO were adju sted monthly to maintain target hematocrit at 35%. At the end of the s tudy (6 mo), despite similar baseline mean hematocrit (31.0 +/- 0.9 ve rsus 33.0 +/- 1.0%), comparable mean baseline weekly rhEPO dose (7886 +/- 1449 versus 6370 +/- 1553 U/wk), and significantly lower level of mean TSAT (11.3 +/- 3.5 versus 30.1 +/- 3.5%; P < 0.05), the ITDI grou p when compared with the oral group had significantly higher mean hema tocrit (36.0 +/- 1.0 versus 31.4 +/- 1.1%; P < 0.05) and TSAT (33.7 +/ - 3.7 versus 22.6 +/- 4.0%; P < 0.05) values. In addition, the final m ean dose of weekly rhEPO was significantly lower in the ITDI group (47 99 +/- 981 versus 9998 +/- 1027 U/wk; P < 0.05). No patient in the ITD I group developed an adverse reaction to intravenous iron. It is concl uded that ITDI represents a more efficacious method of iron supplement ation in PD patients receiving rhEPO. Moreover, ITDI is safe and well tolerated and can be administered in an outpatient setting.