Abstract
Background: An unacceptably high number of patients start dialysis with pronounced anaemia. The aim of this retrospective study was to provide insights into the impact of the pre-dialysis correction of anaemia (using an ESA) and iron deficiency (using oral or IV iron) on the hematological and cardiovascular parameters both at time of onset dialysis as well as for the next 12 months. Methods: Out of the 102 patients, mean age 58.5 (15.9) years, at time of first dialysis in the unit, 70% being males, and 27% having diabetes, 33 patients received IV iron and ESA in the pre-dialysis period versus 69 patients treated with ESA (alone or with oral iron). Results: Patients, in the IV iron group during the pre-dialysis period, commenced dialysis with higher hemoglobin concentrations: 11.1 (1.3) versus 10.4 (1.5) g/dL, (p<0.01), higher iron levels measured by TSAT at 50.0 (19.2) versus 30.1 (15.2)%, (p<0.001), and required lower ESA doses, 0.58 (0.28) versus 0.82 (0.37) µg/kg/week, (p<0.01). There were also differences in the cardiovascular functions with lower left ventricular mass at 116(34) versus 134(39) g/m², (p<0.02), improved left ventricular ejection fraction 64.7 (4.4) versus 61.4(8.7)% (p<0.02) and lower MAP at 104.7 (80) vs. 109(13.2) mmHg (p<0.02), and had fewer hospitalizations, during the first year of dialysis. Conclusions: This observational study is the first to suggest hematological, cardiovascular, and other clinical benefits in the first 12 months of dialysis with the early (pre-dialysis) correction of iron deficiency and anemia using IV iron (and ESA) compared to ESA alone or with oral iron. included patients. Of note, 20.4% of the patients in the placebo group received IV iron compared with only 14.8% in the ESA treated group. In the dialysis setting, the NHCT study [14] demonstrated that the group with the highest Hb target received more IV iron dextran than the group with the lowest Hb target.
Highlights
Anaemia is a common phenomena in patients with chronic kidney diseases (CKD), beginning mostly in stage 3-4 of the disease [1]
Anaemia has been suggested as an independent factor for impaired cardiovascular pathology [3], and may be partly corrected by the addition of iron and Erythropoiesis-Stimulating Agents (ESA), as it was recently underlined by the KDIGO guidelines [4] and the European Renal Best Practice Position Statement [5]
Variance analysis for Hb levels, DA and iron doses were performed using Student-t test: p value
Summary
Anaemia is a common phenomena in patients with chronic kidney diseases (CKD), beginning mostly in stage 3-4 of the disease [1]. The level of correction of anaemia and the target hemoglobin (Hb) and/or iron levels, in order to prevent or correct a cardiovascular pathology and to improve the vital prognosis of these patients is not clearly defined [7]. The impact of such a decision is important, when considering that in the United States 116,946 incident patients started dialysis with a Hb level of 10.57 g/dL and only 25 % of them received pre-dialysis treatment with an ESA [8]. The aim of this retrospective study was to provide insights into the impact of the pre-dialysis correction of anaemia (using an ESA) and iron deficiency (using oral or IV iron) on the hematological and cardiovascular parameters both at time of onset dialysis as well as for the 12 months
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