Intravenous iron plus erythropoietin versus erythropoietin alone for treatment of anaemia in patients of end stage renal disease

A comparative prospective unblinded trial

https://doi.org/10.53730/ijhs.v7nS1.14428

Authors

  • Huma Zahid Resident Internal Medicine, Divisional Headquarter Teaching Hospital, Mirpur AJK, Pakistan
  • Hayyan Tila Khan Medical Officer, DHQ- Hospital, Landikotel KPK, Pakistan
  • Amjad Mehmood Medical Specialist, Divisional Headquarter Teaching Hospital, Mirpur AJK, Pakistan

Keywords:

intravenous iron, maintainence hemodialysis, seum ferritin level, erythropoietin, hemoglobin, iron deficiency anaemia, chronic kidney disease

Abstract

Objective: To determine the efficacy of intravenous iron along with erythropoietin for treatment of anemia in patients of chronic kidney disease undergoing maintenance haemodialysis. Study Design: Randomized comparative prospective, unblinded study. Study Place: Divisional Headquarter Teaching Hospital Mirpur Azad Kashmir. Duration Of Study: 06 Months, from June 2021 to December 2021. Methodology: This study was conducted in Divisional Headquarter Teaching Hospital Mirpur AJK and it included 107 patients with metabolically stable chronic kidney disease with hemoglobin of 8-11 g/dl. Patients were randomly assigned into 2 groups,, ”EPO group” which received subcutaneous erythropoietin only with each hemodialysis session and the “Iron group” which received erythropoietin with each session of hemodialysis and 200mg of intravenous iron once a month with up or down titration every monthly according to hemoglobin and transfer in saturation level in serum. Standard CKD measurement was same in both groups. Serum hemoglobin and serum transferrin saturation was measured at the start of the treatment. Both groups were followed every monthly for efficacy and side effect profile and assessed at 3 months with serum hemoglobin and seum transferrin saturation level. 

Downloads

Download data is not yet available.

References

Gafter-Gvili A, Schechter A, Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta haematologica. 2019;142(1):44-50.

Hanna RM, Streja E, Kalantar-Zadeh K. Burden of anemia in chronic kidney disease: beyond erythropoietin. Advances in therapy. 2021 Jan;38(1):52-75.

Ghasemi F, Abdi A, Salari N, Tohidi MR, Faraji A. Comparing the effects of intravenous and subcutaneous Erythropoietin on blood indices in hemodialysis patients. Scientific reports. 2019 Feb 19;9(1):1-8.

Macdougall IC, Strauss WE, McLaughlin J, Li Z, Dellanna F, Hertel J. A randomized comparison of ferumoxytol and iron sucrose for treating iron deficiency anemia in patients with CKD. Clinical Journal of the American Society of Nephrology. 2014 Apr 7;9(4):705-12.

Roger SD. Practical considerations for iron therapy in the management of anaemia in patients with chronic kidney disease. Clinical Kidney Journal. 2017 Dec 1;10(suppl_1):i9-15.

Locatelli F, Bárány P, Covic A, De Francisco A, Del Vecchio L, Goldsmith D, Hörl W, London G, Vanholder R, Van Biesen W, Era-Edta Erbp Advisory Board. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrology Dialysis Transplantation. 2013 Jun 1;28(6):1346-59.

Gupta N, Wish JB. Erythropoietin and its cardiovascular effects. InCardio-nephrology 2017 (pp. 119-128). Springer, Cham.

Auerbach M, Gafter-Gvili A, Macdougall IC. Intravenous iron: a framework for changing the management of iron deficiency. The Lancet Haematology. 2020 Apr 1;7(4):e342-50.

van Haalen H, Jackson J, Spinowitz B, Milligan G, Moon R. Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: Analysis of multinational real-world data. BMC nephrology. 2020 Dec;21(1):1-5.

Chopra VK, Anker SD. Anaemia, iron deficiency and heart failure in 2020: facts and numbers. ESC heart failure. 2020 Oct;7(5):2007-11.

Weir MR. Managing anemia across the stages of kidney disease in those hyporesponsive to erythropoiesis-stimulating agents. American Journal of Nephrology. 2021;52(6):450-66.

Locatelli F, Bárány P, Covic A, De Francisco A, Del Vecchio L, Goldsmith D, Hörl W, London G, Vanholder R, Van Biesen W, Era-Edta Erbp Advisory Board. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrology Dialysis Transplantation. 2013 Jun 1;28(6):1346-59.

Ganz T, Aronoff GR, Gaillard CA, Goodnough LT, Macdougall IC, Mayer G, Porto G, Winkelmayer WC, Wish JB. Iron administration, infection, and anemia management in CKD: untangling the effects of intravenous iron therapy on immunity and infection risk. Kidney Medicine. 2020 May 1;2(3):341-53.

Guedes M, Muenz DG, Zee J, Bieber B, Stengel B, Massy ZA, Mansencal N, Wong MM, Charytan DM, Reichel H, Waechter S. Serum biomarkers of iron stores are associated with increased risk of all-cause mortality and cardiovascular events in nondialysis CKD patients, with or without anemia. Journal of the American Society of Nephrology. 2021 Aug 1;32(8):2020-30.

Macdougall IC, White C, Anker SD, Bhandari S, Farrington K, Kalra PA, McMurray JJ, Murray H, Steenkamp R, Tomson CR, Wheeler DC. Randomized trial comparing proactive, high-dose versus reactive, low-dose intravenous iron supplementation in hemodialysis (PIVOTAL): study design and baseline data. American journal of nephrology. 2018;48(4):260-8.

Memon S, Qazi N, Laghari J. Comparative Study of Oral versus Intravenous Iron Therapy in Patients of Chronic Renal Failure Receiving Recombinant Human Erythropoietin. Journal of Liaquat University of Medical & Health Sciences. 2019 Apr 10;18(01):42-6.

Published

27-06-2023

How to Cite

Zahid, H., Khan, H. T., & Mehmood, A. (2023). Intravenous iron plus erythropoietin versus erythropoietin alone for treatment of anaemia in patients of end stage renal disease: A comparative prospective unblinded trial. International Journal of Health Sciences, 7(S1), 1859–1866. https://doi.org/10.53730/ijhs.v7nS1.14428

Issue

Section

Peer Review Articles

Most read articles by the same author(s)