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Intermittent versus maintenance iron therapy in children on hemodialysis: a randomized study
Ma de la Cruz Ruiz-Jaramillo1, Juan Manuel Guízar-Mendoza, María de Jesús Gutiérrez-Navarro
1Mexican Institute of Social Security, León, México. maricruiz@salud.gob.mx
Insights
Regular, ferritin-monitored iron therapy is more effective for pediatric renal anemia than intermittent dosing. This approach maintains hemoglobin levels with less iron and reduces iron overload risk.
Area of Science:
- Nephrology
- Pediatric Hematology
- Clinical Nutrition
Background:
- Renal anemia in pediatric patients with end-stage renal failure on hemodialysis often requires iron therapy.
- Current iron therapy options include intermittent or regular low-dose administration.
- Optimizing iron therapy is crucial to manage anemia and prevent complications like iron overload.
Purpose of the Study:
- To compare the efficacy and safety of maintenance iron therapy guided by serum ferritin levels versus intermittent dosing in pediatric patients with end-stage renal failure.
- To assess the impact of different iron therapy regimens on hemoglobin levels, ferritin, transferrin saturation (TSAT), and risk of iron overload.
Main Methods:
- A randomized clinical trial was conducted in pediatric patients with end-stage renal failure and iron deficiency.
- The study group received monthly parenteral iron based on ferritin levels, while the control group received intermittent weekly doses.
- Success was defined by stable ferritin (100-800 microg/l), TSAT (20-50%), and increased hemoglobin.
Main Results:
- Maintenance therapy achieved success in 73% of patients, compared to 38% with intermittent dosing (P=0.009).
- The maintenance group had significantly lower ferritin levels post-treatment (66 microg/l vs. 334 microg/l) and a lower risk of iron overload (19% vs. 70%).
- Hemoglobin levels increased similarly in both groups initially, but the increase was sustained only in the maintenance group, with fewer transfusions needed.
Conclusions:
- Maintenance iron therapy, adjusted for serum ferritin levels, is more efficient than intermittent dosing for pediatric renal anemia.
- This regimen effectively increases and sustains hemoglobin levels using lower iron doses and reduces the risk of iron overload.
- Personalized, ferritin-guided iron management offers a safer and more effective treatment strategy for anemic pediatric patients on hemodialysis.
Abstract:
In patients with renal anemia, iron therapy can be administered intermittently or regularly at a low dose. We performed a randomized clinical trial in pediatric patients with end-stage renal failure on hemodialysis and absolute or functional iron deficiency. The study group received maintenance iron therapy according to the ferritin serum levels and the control group received intermittent 10-weekly doses. Success was defined as stabilization of ferritin levels between 100 and 800 microg/l and transferrin saturation (TSAT) between 20% and 50%, in addition to an increase in the hemoglobin level. The major reason for exclusion was iron overload. The study group received 6 mg/kg per month of parenteral iron [95% confidence interval (CI) 3.3-8.8] and the control group 14.4 mg/kg per month (95% CI 12-16.8) ( P<0.001). After 4 months of treatment, ferritin levels increased to 66 microg/l (95% CI 69-200) in the study group and to 334 microg/l (95% CI 145-522) in the control group ( P=0.009). Maintenance therapy and intermittent weekly doses were successful in 73% and 38%, respectively. After 3 months of treatment, hemoglobin levels increased to 10 g/dl, with no difference between the groups. However, in the control group the increase in hemoglobin levels was unsustained, and 3 patients needed transfusion. Patients in the control group had a higher risk of iron overload than patients in the study group (70% vs. 19%). Thus, the regimen based on assessment of serum ferritin levels was more efficient than the intermittent regimen because it increased and maintained the hemoglobin levels with lower iron doses and a lower risk of iron overload.
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