Abstract
BackgroundAlthough the efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) in treating anemia in hemodialysis (HD) patients has been studied individually, a comparison of these two intravenous iron formulations has not yet been performed in HD patients.MethodsWe performed a retrospective audit on records of 221 stable HD patients from different HD centers in the Netherlands, who were switched from IS to FCM on a 1:1 ratio. To assess the effect of the switch on iron status parameters, data from 3 time points before and 3 time points after the switch were analyzed using linear mixed effects models. Subanalyses were done in 2 subgroups of patients anemic or iron deficient at baseline.ResultsHemoglobin increased in all groups (anemic [1.4 g/dL, P < 0.001] iron deficient [0.6 g/dL, P < 0.001]), while the weekly iron dose was significantly lower when patients received FCM compared to IS (48 vs 55 mg/week, P = 0.04). Furthermore, serum ferritin and transferrin saturation increased in all groups (anemic [64 μg/L, 5.0%, P < 0.001] iron deficient [76 μg/L, 3.6%, P < 0.001]). Finally, the darbepoetin α dose decreased significantly in all groups (anemic [− 16 μg/wk., P = 0.01] iron deficient [− 11 μg/wk., P < 0.001]).ConclusionsIn this real-life study in HD patients, a switch from IS to FCM resulted in an improvement of iron status parameters despite a lower weekly dose of FCM. Furthermore, the ESA dose was reduced during FCM, while hemoglobin levels increased.
Highlights
The efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) in treating anemia in hemodialysis (HD) patients has been studied individually, a comparison of these two intravenous iron formulations has not yet been performed in HD patients
There was no significant correlation between ferritin and C-reactive protein (CRP) at baseline in the entire group (β − 0.090, P = 0.33), the anemic group (β 0.286, P = 0.32), or the iron deficient group (β − 0.128, P = 0.64)
For all the other variables the results were similar to those described for the entire population. In this analysis, we have shown that the switch from IS to FCM in HD patients was associated with a significant improvement of iron status, unrelated to iron dose
Summary
The efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) in treating anemia in hemodialysis (HD) patients has been studied individually, a comparison of these two intravenous iron formulations has not yet been performed in HD patients. Anemia is a frequent complication of chronic kidney disease (CKD) [1]. In CKD, the main causes of anemia are deficiency of erythropoietin, iron-restricted erythropoiesis and anemia of the chronic disease (ACD) [2,3,4]. The latter originates from the chronic inflammation that is a hallmark of CKD patients and has been shown to be associated with adverse outcomes such as cardiovascular events, end-stage renal disease, increased mortality, and decreased quality of life [5]. It has been established that intravenous iron supplementation as a treatment for iron deficiency anemia is superior
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