Beneficial effects of adopting an aggressive intravenous iron policy in a hemodialysis unit

Iron deficiency is the most common cause of a suboptimal response to epoeti n therapy, and the treatment of choice is intravenous (IV) iron. It is also increasingly recognized that IV iron can enhance the response to epoetin, even in iron-replete patients. The aim of the present study was to examine the effects of adopting an aggressive IV iron policy in all patients attend ing a single-center hemodialysis unit. The protocol was simple and practica l, and involved administering a weekly IV bolus of 100 mg iron sucrose to a ll patients with a serum ferritin level of 150 to 1,000 mu g/L. Only patien ts with a serum ferritin level greater than 1,000 mu g/L were excluded; pat ients with a serum ferritin level below 150 mu g/L were given a more aggres sive IV dosing regimen to get into range for the standard protocol. Among 1 16 patients included in the study, the mean serum ferritin level increased from 214 mu g/L in November 1997 to 564 mu g/L in November 1998 (P < 0.0001 ). Mean hemoglobin increased modestly from 9.6 g/dL to 10.7 g/dL over the s ame period, but there was a dramatic reduction in mean epoetin dose from 13 ,277 U/wk to 8,976 U/wk (P < 0.0005), resulting in cost savings of approxim ately pound 228,000 ($366,000), or pound 152 ($244) per patient per month. No adverse reactions to IV iron were seen among a total of 4,564 injections , and there was no obvious increase in the incidence of infection. This sim ple, practical IV iron dosing policy resulted in dramatic savings in epoeti n dosage and cost with no significant adverse effects. (C) 1999 by the Nati onal Kidney Foundation, Inc.