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The Impact of Intravenous Iron Supplementation on Hematinic Parameters and Erythropoietin Requirements in Hemodialysis Patients

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Abstract

Introduction

Anemia is one of the most common complications of chronic kidney disease (CKD). As a result of the side effects of high doses of recombinant human erythropoietin (rhEPO) and the differences in the standard dose of the injectable iron, this study aimed to evaluate the effect of high and low intravenous iron supplementation on hematinic parameters and EPO requirements in patients under hemodialysis.

Methods

This multicenter, randomized, double-blind clinical trial was conducted on 60 patients with CKD admitted to Sina and 29 Bahman hospitals in Tabriz, Iran in 2019–2020 to undergo hemodialysis. In the two studied groups, low (100 mg/week) and high (400 mg/week) doses of iron were administered and subjects were followed up for 6 months. The incidence of acute myocardial ischemia, stroke, and mortality during 6 months was recorded.

Results

The required rhEPO dosage (mg/week) to maintain hemoglobin levels between 10 and 12 g/dL in the high-dose iron group was significantly decreased during the follow-up period (52,129.03 ± 23,810 vs. 45,760 ± 20,978.71, P ≤ 0.028). Transferrin saturation (TSAT) index had a significant upward trend after iron injection and significant correlations with the serum levels of Fe (r ≥ 0.353, P ≤ 0.007), ferritin (r ≥ 0.315, P ≤ 0.016), and total iron binding capacity (r ≥ 0.219, P < 0.050) during the follow-up period in the studied groups.

Conclusion

High-dose intravenous iron (400 mg/week) can reduce the mean dose of rhEPO requirements and increase the TSAT index over a period of 6 months in hemodialysis patients. High-dose IV iron administration can decrease cardiovascular events in hemodialysis patients with iron deficiency anemia.

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Acknowledgements

Funding

The authors thank the Kidney Research Center at Tabriz University of Medical Sciences for its support and assistance. No funding or sponsorship was received for this study or publication of this article.

Authorship

All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All authors had full access to all of the data for this analysis and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Authorship Contributions

Farahnoosh Farnood was involved in the conception and design of this study. Seyedeh Mina Hejazian and Saba Esmaeili collected the data. Sepideh Zununi Vahed and Seyedeh Mina Hejazian performed the data analysis and interpretation of results. Elham Ahmadian prepared the first draft of the manuscript. Sepideh Zununi Vahed and Farahnoosh Farnood did a critical revision of the manuscript. All authors read and approved the final manuscript.

Disclosures

Sepideh Zununi Vahed, Elham Ahmadian, Seyedeh Mina Hejazian, Saba Esmaeili, and Farahnoosh Farnood have nothing to disclose.

Compliance with Ethics Guidelines

This study was performed in accordance with the Helsinki Declaration of 1964 and its later amendments. This study was permitted by the Ethics Committee of Azad University of Tabriz branch (IR.IAU.TABRIZ.REC.1399.083). The study was registered with the Iran Clinical Trials Registry with identifier number IRCT20201108049311N1 (https://www.irct.ir). A consent form was signed by each of the participants and they were advised to use their regular medications during the study period.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Sepideh Zununi Vahed, Elham Ahmadian, Seyedeh Mina Hejazian & Farahnoosh Farnood

  2. Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

    Seyedeh Mina Hejazian

  3. Faculty of Medicine, Islamic Azad University of Tabriz Branch, Tabriz, Iran

    Saba Esmaeili & Farahnoosh Farnood

Authors
  1. Sepideh Zununi Vahed
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Corresponding author

Correspondence to Farahnoosh Farnood.

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Zununi Vahed, S., Ahmadian, E., Hejazian, S.M. et al. The Impact of Intravenous Iron Supplementation on Hematinic Parameters and Erythropoietin Requirements in Hemodialysis Patients. Adv Ther 38, 4413–4424 (2021). https://doi.org/10.1007/s12325-021-01826-3

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