Iron supplementation therapy in end-stage renal disease, hemodialysis patients
a clinical trial
DOI:
https://doi.org/10.22491/2357-9730.125379Keywords:
Anemia, end-stage renal disease, iron therapy, erythropoietin, hemodialysisAbstract
OBJECTIVE: To evaluate iron deficiency and to compare effectiveness of oral and parenteral iron supplementation in end-stage renal disease, hemodialysis patients.
PATIENTS AND METHODS: Thirty-nine end-stage renal disease, hemodialysis patients were evaluated for age; weight; etiology of chronic renal failure; duration of hemodialysis; use of recombinant human erythropoietin; serum albumin, serum hemoglobin, hematocrit, and serum ferritin levels; and iron status. Iron status was assessed based on the following equation: [400 x log (serum ferritin) - log 30] - [150 x (11.55 - hemoglobin)] =
iron status Patients were considered iron-deficient when the equation gave a negative result. Next, these patients were randomly divided into 2 groups. Patients with recent bleeding episodes or blood transfusion were excluded from the study. Group I received oral iron sulfate and group II intravenous iron hydroxide saccharate. The dosage was calculated based
on the iron status and body weight and adjusted for estimated bioavailability.
RESULTS: Twenty-four (62%) patients were iron-deficient, out of which 19 completed the trial (11 patients in group I and 8 in group II). In the comparison with baseline values, group II had a significant increase in hematocrit (3.25 ± 3.69%, P < 0.05), serum hemoglobin (0.98 ± 0.86 g/dl, P < 0.02), serum ferritin (245 ± 133 ng/ml, P <0.01) and iron status (316.20 ± 214.230 mg, P < 0.01), whereas group I did not. In the comparison of group I and group II, the latter indicated greater increase in hematocrit, serum hemoglobin, serum ferritin and iron status (P < 0.05). Group II patients not using erythropoietin (5 of 8 patients), when compared to Group I, presented a greater increase in serum hemoglobin (0.8 ± 0.6 g/dl) and hematocrit (2.2± 3.4 %, P < 0.05).
CONCLUSIONS: Considering equivalent dosages, intravenous iron therapy was more effective than oral therapy in increasing hematocrit, serum hemoglobin, serum ferritin, and iron status in hemodialysis patients with chronic renal disease. Patients not usingrecombinant human erythropoietin could benefit only from intravenous iron therapy.
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