Intravenous iron dextran treatment in predialysis patients with chronic renal failure

Iron deficiency anemia is common in patients with chronic renal failure not undergoing hemodialysis. Current therapy consists of oral or intravenous ( IV) iron dextran (IVID). The standard IV regimen is 100 to 200 mg/dose for a 1-g total dose. We hypothesized that 500 mg/wk of IVID for two doses woul d be less costly and equally effective as 200 mg/wk for five doses. We pros pectively studied 22 patients with creatinine clearances less than 50 mL/mi n who were not undergoing dialysis and had anemia and evidence of iron defi ciency (ferritin level <100 ng/mL or transferrin saturation [TSAT] <20%). P atients were randomized into two groups: group I (n = 8), 200 mg/wk of IVID for 5 weeks, and group II (n = 14), 500 mg/wk of IVID for;! weeks. AII pat ients tolerated IVID infusions without serious adverse reactions. Over the 6-month follow-up, both groups experienced an increase in hemoglobin levels from baseline. Ferritin levels in both groups increased (P < 0.005), peake d at 2 weeks, then declined thereafter. Over the 6-month follow-up, both gr oups experienced significant improvement, although the beneficial effects o f group II declined at a significantly faster rate than group I (P = 0.003) . There was no significant difference in change in ferritin levels between groups. TSAT peaked at 2 weeks in both groups (P < 0.001). Group I experien ced a significant increase in TSAT throughout the 6-month follow-up (P < 0. 03), and group II achieved a significant increase in TSAT at 2 weeks, but n ot at 3 and 6 months. There was no significant difference in pretreatment t o posttreatment change in TSAT. Treatment in group II was 35.2% more cost-e ffective than in group 1 ($965 versus $1,490, respectively). We conclude th at IVID, 500 mg/wk, for 2 weeks is as effective and safe as 200 mg/wk for 5 weeks, but much less costly. (C) 2000 by the National Kidney Foundation, I nc.