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

Abstract

Iron deficiency is the most common cause of a suboptimal response to epoetin 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 attending a single-center hemodialysis unit. The protocol was simple and practical, and involved administering a weekly IV bolus of 100 mg iron sucrose to all patients with a serum ferritin level of 150 to 1,000 microg/L. Only patients with a serum ferritin level greater than 1,000 microg/L were excluded; patients with a serum ferritin level below 150 microg/L were given a more aggressive IV dosing regimen to get into range for the standard protocol. Among 116 patients included in the study, the mean serum ferritin level increased from 214 microg/L in November 1997 to 564 microg/L in November 1998 (P < 0.0001). Mean hemoglobin increased modestly from 9.6 g/dL to 10.7 g/dL over the same 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 approximately 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 simple, practical IV iron dosing policy resulted in dramatic savings in epoetin dosage and cost with no significant adverse effects.