Assessment of Erythropoietin Efficacy in Treatment of Anemia in Pre-dialysis Chronic Kidney Disease Patients

Abstract

Background: Anemia is the most frequent condition in patients suffering from chronic renal disease. Iron supplements are commonly prescribed for these patients using oral and intravenous iron with or without erythropoietin therapy. Objectives: This study aimed at comparing the efficacy of IV iron versus oral iron in raising hemoglobin levels in predialysis chronic kidney disease (CKD) patients. Patients and Methods: A prospective cohort study that was conducted in Met-Ghamr Hospital of Nephrology and Urology from February 2019 to July 2019. The study included 50 CKD patients with anemia in the pre-dialysis stage. Group 1 consisted of 25 patients that were given IV iron while the 25 patients of group 2 were given oral iron. Both groups were monitored for 4 months for changes in hemoglobin levels and side effects. After the initial 4 months, patients in both groups who did not have a sufficient hemoglobin response to iron supplementation were prescribed an additional erythropoiesis-stimulating agent (ESA) with monitoring of hemoglobin response for the consequent 2 months. Results: We found a significant difference in the hemoglobin response between the two sets of patients in favor of the IV route after 4 months. We also found the safety profile of both routes to be comparable. After 4 months, the patients that received additional dose of Epoetin alfa (4000 IU/week for 2 months) showed a significant rise in hemoglobin level over the next 2 months compared to patients who did not receive the additional dose. Conclusion: We concluded that intravenous iron supplement is better than oral iron supplement in correction of anemia in pre-dialysis patients.