Abstract
Target
To observe the effect on hemoglobin (Hb) variability with different treatment frequencies of intravenous iron in maintenance hemodialysis (MHD) patients.
Methods
There were 41 MHD patients enrolled in the cohort. The patients were separated into two groups randomly. The baseline data were collected after oral iron agents for 1 month (wash out). There were two methods of intravenous iron administration, either continuous or intermittent. For continuous administration (CA), 100 mg sucrose iron agents were given during every HD session with total dose of 1000 mg. For intermittent administration (IA), 100 mg sucrose iron agents were given once every week with the same total dose of 1000 mg. The protocol were designed to do a follow-up of 7 months, which included two to three-month steps of different administrations of intravenous iron and 1 month of wash-out period by oral iron agents between two steps, respectively. Patients in Group one (G1) administrated iron agents by CA at the first step and IA at the second step. Patients in Group two (G2) did IA and then transfer to CA. The clinical parameters including Hb, serum ferritin (SF), transferrin saturation (TAST), and doses of recombined human erythropoietin (rHuEPO) were detected and recorded during follow-up period. The standard deviation of Hb (Hb-SD) and coefficient variation of Hb (Hb-CV) were calculated. The baseline data were compared between two groups. The parameters on month 3 and 7 were compared with those on month 0 in two groups, respectively. The effects of both CA and IA on Hb-SD and Hb-CV were compared by two-stage cross-comparison general linear model (GLM) method.
Results
There were 34 patients (82.9%) completed the trail. The amounts of cases, rates of gender and primary diseases, the mean value of age, Hb, SF, TSAT, and doses of rHuEPO on baseline in two groups were similar (p > 0.05). The SF levels in two groups increased significantly during follow-up period, which were 235.4 ± 51.8 ng/ml on month 0, 362.4 ± 140.2 ng/ml on month 3, and 315.0 ± 97.73 ng/ml on month 7 in G1 (p < 0.01), and 250.5 ± 37.8 ng/ml, 332.2 ± 118.9 ng/ml, and 347.4 ± 124.3 ng/ml in G2 (p < 0.01), respectively. Compared to CA, IA could decline the Hb-SD (5.93 ± 3.97 g/l vs. 7.36 ± 3.81 g/l, F = 4.377, p = 0.044) and Hb-CV (0.054 ± 0.035 vs. 0.069 ± 0.030, F = 7.042, p = 0.012) significantly. The mean levels of Hb and doses of rHuEPO were similar between CA and IA.
Conclusion
The administration of intravenous iron by CA or IA has the similar effects on iron supplement and anemia treatment. However, IA may be more benefit to Hb variability than CA in MHD patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Zhang L, Zhang A, Zhu N et al (2015) Hemoglobin variation is associated with cardio-cerebro-vascular events and thrombosis in arteriovenous fistula in hemodialysis patients. Chin J Blood Purif 6:337–341
Kessler M, Landais P, Bataille P et al (2011) Hemoglobin level variability in hemodialysis patients treated with epoetin-beta during 1 year. Clin Nephrol 76(3):210–217
Spiegel DM, Khan I, Krishnan M et al (2010) Changes in hemoglobin level distribution in US dialysis patients from June 2006 to November 2008. Am J Kidney Dis 55(1):113–120
Watschinger B, Salmhofer H, Horn S et al (2013) The MAINTAIN Study—managing hemoglobin variability with darbepoetin alfa in dialysis patients experiencing a severe drop in hemoglobin. Wien Klin Wochenschr 125(3–4):71–82
Rozen-Zvi B, Gafter-Gvili A, Paul M, Leibovici L, Shpilberg O, Gafter U (2008) Intravenous versus oral iron supplementation for the treatment of anemia in CKD: systematic review and meta-analysis. Am J Kidney Dis 52(5):897–906
Provenzano R, Schiller B, Rao M, Coyne D, Brenner L, Pereira BJ (2009) Ferumoxytol as an intravenous iron replacement therapy in hemodialysis patients. Clin J Am Soc Nephrol 4(2):386–393
Yahiro M, Kuragano T, Kida A et al (2012) The impact of ferritin fluctuations on stable hemoglobin levels in hemodialysis patients. Clin Exp Nephrol 16(3):448–455
Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group (2012) KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl(2):279–335
Pisoni RL, Bragg-Gresham JL, Fuller D et al (2011) Facility-level interpatient hemoglobin variability in hemodialysis centers participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS): associations with mortality, patient characteristics, and facility practices. Am J Kidney Dis 57(2):266–275
Cai H, Zhang WM, Yan Y et al (2014) Hemoglobin variability is associated with mortality in patients on maintenance hemodialysis. Chin J Blood Purif. 1:12–16
Chen N, Qian J, Mei CL et al (2012) The efficacy and safety of continuous erythropoietin receptor activator in dialytic patients with chronic renal anemia: an open, randomized, controlled, multi-center trial. Chin J Intern Med 51(7):502–506
Gong R, Pi J, Chen Z et al (2014) Comparative study of hemoglobin variability between maintenance peritoneal dialysis and hemodialysis. Chin J Clin (Electron Ed) 7:1216–1220
National Kidney Foundation IV (2001) NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kinney Disease: update 2000. Am J Kidney Dis 37(1 suppl 1):S182–S238
Tsubakihara Y, Nishi S, Akiba T et al (2010) 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial 14:240–275
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Author Li Wan declares that she has no conflict of interest. Author Dongliang Zhang declares that he has no conflict of interest either.
Ethical approval
All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Wan, L., Zhang, D. Effect of frequency of intravenous iron administration on hemoglobin variability in maintenance hemodialysis patients. Int Urol Nephrol 50, 1511–1518 (2018). https://doi.org/10.1007/s11255-018-1916-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-018-1916-8