Abstract
BackgroundIron deficiency is common in non-dialysis chronic kidney disease (ND-CKD) patients and, on occasion, requires parenteral iron therapy. We investigated the effect of intravenous iron repletion on platelet counts in ND-CKD patients with and without concomitant darbepoetin administration.MethodsWe conducted a retrospective analysis of ND-CKD patients with iron deficiency anemia treated with low molecular weight iron dextran (LMWID) between 2005 and 2009 at our CKD clinic. The primary end-point was change in platelet count 60 days post infusion of LMWID in those with and without concomitant darbepoetin administration. Secondary end-points were the correlations between changes in platelet count and iron indices.ResultsA total of 108 patients met inclusion and exclusion criteria. The decrease in platelet counts in response to iron repletion was statistically significant (305.72 ± 108.86 vs 255.58 ± 78.97, P = < .0001). The decrease in platelet count was independent of concomitant darbepoetin use. Bivariate regression analysis between baseline platelet count and transferrin saturation by iron (TSAT) showed a negative association (βTSAT = −5.82, P = .0007) and moderate correlation (R = 0.32). Following iron treatment, the within individual changes in platelet count in 60 days were not related to changes in TSAT (βΔTSAT = −0.41, P = .399) and demonstrated a poor correlation (R = 0.10).ConclusionsParenteral iron treatment by LMWID is associated with reduction in platelet counts in iron deficient anemic ND-CKD patients. However, ESA use in the majority of patients prior to intravenous iron administration could have altered platelet production through bone marrow competition.
Highlights
Iron deficiency is common in non-dialysis chronic kidney disease (ND-CKD) patients and, on occasion, requires parenteral iron therapy
Some have suggested that reactive thrombocytosis, induced by erythropoiesis stimulating agents (ESA) or the resulting iron depletion, may have contributed to the higher-than-expected rates of cerebrovascular accidents and thrombotic events reported in clinical trials of ESA in chronic kidney disease (CKD) patients
At the Henry Ford Hospital Chronic Kidney Disease Clinic, low molecular weight iron dextran (LMWID) in conjunction with ESA is used for non-dialysis chronic kidney disease (ND-CKD) anemia management using a computerized algorithm for dosing
Summary
Iron deficiency is common in non-dialysis chronic kidney disease (ND-CKD) patients and, on occasion, requires parenteral iron therapy. Some have suggested that reactive thrombocytosis, induced by ESA or the resulting iron depletion, may have contributed to the higher-than-expected rates of cerebrovascular accidents and thrombotic events reported in clinical trials of ESA in chronic kidney disease (CKD) patients. At the Henry Ford Hospital Chronic Kidney Disease Clinic, low molecular weight iron dextran (LMWID) in conjunction with ESA is used for non-dialysis chronic kidney disease (ND-CKD) anemia management using a computerized algorithm for dosing. We undertook the present study to evaluate the temporal effect of intravenous iron administration on platelet counts in iron deficient ND-CKD patients and determine if the effect is dependent on concurrent ESA administration
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