Abstract
In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. Ferric carboxymaltose (FCM) is a relatively novel intravenous iron formulation used in different clinical settings, although scarce data exist in NDD-CKD patients. Primary objective of this study was to retrospectively evaluate the efficacy of FCM compared with oral ferrous sulfate for the treatment of iron-deficiency anemia in a cohort of NDD-CKD patients, considering also the treatment costs. This was a monocentric, retrospective observational study reviewing 349 NDD-CKD patients attending an outpatient clinic between June 2013 and December 2016. Patients were treated by either FCM intravenous infusion or oral ferrous sulfate. We collected serum values of hemoglobin, ferritin and transferrin saturation (TSAT) and ESAs doses at 12 and 18 months. The costs related to both treatments were also analysed. 239 patients were treated with FCM intravenous infusion and 110 patients with oral ferrous sulfate. The two groups were not statistically different for age, BMI and eGFR values. At 18 months, hemoglobin, serum ferritin and TSAT values increased significantly from baseline in the FCM group, compared with the ferrous sulfate group. ESAs dose and rate of infusion decreased only in the FCM group. At 18 months, the treatment costs, analysed per week, was higher in the ferrous sulfate group, compared with the FCM group, and this was mostly due to a reduction in ESAs prescription in the FCM group. Routine intravenous FCM treatment in an outpatient clinic of NDD-CKD patients results in better correction of iron-deficiency anemia when compared to ferrous sulfate. In addition to this, treating NDD-CKD patients with FCM leads to a significant reduction of the treatment costs by reducing ESAs use.
Highlights
In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management
Anemia is a common condition in patients with chronic kidney disease (CKD) and it is associated with increased morbidity and mortality[1,2]
The prevalence and severity of anemia are directly related to the degree of renal failure[4], and in this specific pathological condition it is caused by a multifactorial etiopathogenetic mechanism: decreased erythropoietin production by failing kidneys, iron deficiency due to dietary restriction, decreased red blood cell half-live, decreased erythropoietic response in the bone marrow related to inflammation and uremic toxins, increased hepcidin levels related to chronic inflammation, which contributes to anemia by downregulating both intestinal iron absorption and release of stored iron, and determining hypo responsiveness to erythropoiesis-stimulating agents (ESAs)[1,5]
Summary
In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. The prevalence and severity of anemia are directly related to the degree of renal failure[4], and in this specific pathological condition it is caused by a multifactorial etiopathogenetic mechanism: decreased erythropoietin production by failing kidneys, iron deficiency due to dietary restriction, decreased red blood cell half-live, decreased erythropoietic response in the bone marrow related to inflammation and uremic toxins, increased hepcidin levels related to chronic inflammation, which contributes to anemia by downregulating both intestinal iron absorption and release of stored iron, and determining hypo responsiveness to erythropoiesis-stimulating agents (ESAs)[1,5] Due to this heterogeneous etiopathogenesis, a substantial number of patients remains anemic, despite currently available therapies[4]. Long-term follow-up studies in this population are scarce[6,7], and only one trial, the FIND-CKD study, has been performed so far[14]
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