EFFECTIVE UTILIZATION OF ERYTHROPOIETIN WITH INTRAVENOUS IRON THERAPY

Introduction: Iron replacement therapy reduces the demand for erythrop oietin (EPO) in some dialysis patients. It has been postulated that ir on supply to the bone marrow is a rate-limiting step in the process of erythropoiesis under erythropoietin stimulation. Methods: We evaluate d the economic benefit of intravenous iron therapy for this purpose in a prospective, non-blinded study of 22 haemodialysis patients, 16 mal e, six female, mean age 62 years (range 24-80 years). All patients had a serum ferritin (SF) of less than or equal to 60 mu g/L, despite ora l iron therapy. Patients with high aluminium and/or parathyroid hormon e (PTH) levels, underlying bleeding/haematological disorders or active inflammatory diseases were excluded. Patients were established on sub cutaneous EPO and given intravenous iron over seven consecutive dialys is sessions (total dose 1050 mg) and supplemental monthly doses with r egular monitoring for 4 months. Results: The median EPO dose was 4000 units/week (mean 6050 units/week) pre-treatment and 2000 units/week (m ean 3700 units) at 6 weeks post intravenous iron therapy (P=0.03). No serious adverse events occurred in the 154 treatment sessions of intra venous iron. Mean haemoglobin (Hb) level remained constant at 6 and 12 weeks (P=0.087). Serum ferritin levels (P< 0.0001) rose significantly , while a reduction in transferrin saturation (TS) became significant at the end of the study (P=0.0047). The use of intravenous iron allowe d a substantial monthly cost saving per patient in our unit. Conclusio n: Intravenous iron therapy is a safe and cost-effective method for ma intaining or improving Hb levels with a more effective utilization of EPO in patients with low SF levels despite oral iron therapy.