The effectiveness of low-dose maintenance i.v. iron therapy: a dialysis facility's experience

Over the past few decades, anemia management in patients with chronic kidney disease and end stage renal disease (ESRD) has advanced significantly. However, these improvements appear to have leveled off, with data from the ESRD Clinical Performance Measures Project showing that, over each of the past 3 years, approximately 80% of patients on hemodialysis were being managed at, or above, the minimum recommended hemoglobin (Hgb) level of 11 g/dL (Centers for Medicare & Medicaid Services, 2005). There are a number of potential reasons for this leveling off. Thus, it is important to carefully evaluate the etiology of the anemia in each patient. One area that needs to be examined involves the use of IV iron therapy. In an effort to improve anemia management, it is important for dialysis facilities to routinely examine their current IV iron protocol to determine its effectiveness in maintaining patients within the recommended target ranges for serum ferritin, transferrin saturation (TSAT), and Hgb levels. Recently the Milford Dialysis Unit took a proactive approach to improving anemia management by assessing the utility of their IV iron maintenance protocol. This review will examine the results of this analysis and provide strategies on how to improve anemia management practices in a dialysis facility.