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Intra-dialytic oral iron therapy
G Dunea1, M A Swagel, U Bodiwala
1Cook Country Hospital, Hektoen Institute for Medical Research, WSKC Dialysis-Services, Chicago, IL.
Abstract:
In order to test the limits of what can be achieved with oral iron therapy and eliminate the factor of noncompliance, we conducted a series of observational studies in an 140-patient inner city dialysis unit. In these studies the patients received supervised iron therapy as 3-4 ferrous sulfate (325 mg) tablets during each dialysis. Acceptance and tolerance was high, less than 10% refusing to take the tablets. In two separate observational studies oral intradialytic iron yielded a hematocrit 28% in 69% of patients and 30% in 42-52%. There was no correlation between the final hematocrit and serum ferritin or transferrin saturation. The response to iron therapy could frequently not be predicted by the ferritin levels or transferrin saturation. We conclude that in view of the known hazards of intravenous iron dextran, oral intradialytic therapy should be tried first and that a good response can be expected in one half to two thirds of hemodialysis patients.
Insights
Oral iron therapy during dialysis is effective for many patients, improving hematocrit levels. This supervised intradialytic approach offers a safe alternative to intravenous iron, with good patient acceptance.
Area of Science:
- Nephrology
- Hematology
- Clinical Trials
Background:
- Anemia is common in hemodialysis patients.
- Oral iron therapy adherence can be a challenge.
- Intravenous iron dextran has known risks.
Purpose of the Study:
- To evaluate the efficacy and tolerability of oral iron therapy in hemodialysis patients.
- To assess the impact of supervised intradialytic oral iron on hematocrit levels.
- To determine if baseline ferritin or transferrin saturation predict response.
Main Methods:
- Observational studies conducted in a 140-patient inner-city dialysis unit.
- Patients received supervised oral ferrous sulfate (325 mg) tablets during dialysis.
- Hematocrit, serum ferritin, and transferrin saturation were monitored.
Main Results:
- High acceptance and tolerance of oral iron therapy (less than 10% refusal).
- Oral intradialytic iron achieved hematocrit ≥28% in 69% of patients and ≥30% in 42-52%.
- No correlation found between final hematocrit and serum ferritin or transferrin saturation; response was unpredictable by these markers.
Conclusions:
- Oral intradialytic iron therapy is a viable and well-tolerated option for hemodialysis patients.
- A significant proportion of patients can expect a good hematocrit response.
- This approach should be considered before resorting to intravenous iron due to safety concerns.