Effectiveness of oral iron to manage anemia in long-term hemodialysis patients with the use of ultrapure dialysate

Tsuchida,Akiyasu; Paudyal,Bishnuhari; Paudyal,Pramila; Ishii,Yoshitaka; Hiromura,Keiju; Nojima,Yoshihisa; Komai,Minoru

doi:10.3892/etm.2010.122

Effectiveness of oral iron to manage anemia in long-term hemodialysis patients with the use of ultrapure dialysate

Authors:
- Akiyasu Tsuchida
- Bishnuhari Paudyal
- Pramila Paudyal
- Yoshitaka Ishii
- Keiju Hiromura
- Yoshihisa Nojima
- Minoru Komai
View Affiliations

Affiliations: Sanshi Group Hikari Clinic, Internal Medicine and Kidney Dialysis, Gunma 379-2201, Japan, Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Gunma 371-851, Japan, Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma 371-851, Japan
Published online on: July 20, 2010 https://doi.org/10.3892/etm.2010.122
Pages: 777-781

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of this study was to evaluate the effectiveness of oral iron to manage anemia in long-term hemodialysis (HD) patients using ultrapure dialysate. This study was prospectively conducted on 23 patients (11 males and 12 females; median age 60 years, range 35-81) who underwent HD in our hospital from March to September 2007. The patients were randomly assigned to two treatment groups. The first group of 11 patients received ferrous fumarate 305 mg per oral tablet once a day, while the second group of 12 patients received infusions of 50 mg iron in a 0.9% sodium chloride solution. At the end of the 6-month treatment, patients receiving oral iron and intravenous iron had a significant increase in transferrin saturation from baseline (20.1±8.9 to 29.7±7.2; p=0.011 and 17.4±6.1 to 33.7±8.6; p=0.0001, respectively) and ferritin (32.6±15.4 to 115.4±28.2; p=0.0001 and 57.8±26.7 to 183.5±47.5; p=0.0002, respectively). In both groups, hemoglobin, hematocrit and dry weight were increased, but did not reach statistical significance. Moreover, both groups showed a significant reduction in the mean weekly erythropoietin dose from baseline (5,590.9±1,513.6 to 3,727.3±1,618.1; p=0.011 and 6,775.8±2,292.2 to 4,375.0±2,473.7; p=0.027, respectively). Oral iron is indeed as effective as intravenous iron in managing anemia in HD patients using ultrapure dialysate.

View Figures

View References

1.	Van Wyck D, Eckardt KU, Uhlig K, Rocco M and Levin A: Appraisal of evidence and control of bias in the kidney disease outcomes quality initiative guideline development process. Clin J Am Soc Nephrol. 2:8–10. 2007.PubMed/NCBI
2.	Fishbane S, Kalantar-Zadeh K and Nissenson AR: Serum ferritin in chronic kidney disease: reconsidering the upper limit for iron treatment. Semin Dial. 17:336–341. 2004. View Article : Google Scholar : PubMed/NCBI
3.	Kalantar-Zadeh K, McAllister CJ, Lehn RS, Lee GH, Nissenson AR and Kopple JD: Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis. 42:761–773. 2003. View Article : Google Scholar : PubMed/NCBI
4.	Fishbane S and Maesaka JK: Iron management in end-stage renal disease. Am J Kidney Dis. 29:319–333. 1997. View Article : Google Scholar : PubMed/NCBI
5.	Wingard RL, Parker RA, Ismail N and Hakim RM: Efficacy of oral iron therapy in patients receiving recombinant human erythropoietin. Am J Kidney Dis. 25:433–439. 1995. View Article : Google Scholar : PubMed/NCBI
6.	Kapoian T, O'Mara NB, Singh AK, et al: Ferric gluconate reduces epoetin requirements in hemodialysis patients with elevated ferritin. J Am Soc Nephrol. 19:372–379. 2008. View Article : Google Scholar : PubMed/NCBI
7.	Macdougall IC: Intravenous administration of iron in epoetin-treated haemodialysis patients – which drugs, which regimen? Nephrol Dial Transplant. 15:1743–1745. 2000.
8.	Coyne DW, Kapoian T, Suki W, et al: Ferric gluconate is highly efficacious in anemic hemodialysis patients with high serum ferritin and low transferrin saturation: results of the Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) Study. J Am Soc Nephrol. 18:975–984. 2007.PubMed/NCBI
9.	Rozen-Zvi B, Gafter-Gvili A, Paul M, Leibovici L, Shpilberg O and Gafter U: Intravenous versus oral iron supplementation for the treatment of anemia in CRF: systematic review and meta-analysis. Am J Kidney Dis. 52:897–906. 2008. View Article : Google Scholar : PubMed/NCBI
10.	Lenga I, Lok C, Marticorena R, Hunter J, Dacouris N and Goldstein M: Role of oral iron in the management of long-term hemodialysis patients. Clin J Am Soc Nephrol. 2:688–693. 2007. View Article : Google Scholar : PubMed/NCBI
11.	Stoves J, Inglis H and Newstead CG: A randomized study of oral vs intravenous iron supplementation in patients with progressive renal insufficiency treated with erythropoietin. Nephrol Dial Transplant. 16:967–974. 2001. View Article : Google Scholar : PubMed/NCBI
12.	Charytan C, Qunibi W and Bailie GR: Comparison of intravenous iron sucrose to oral iron in the treatment of anemic patients with chronic kidney disease not on dialysis. Nephron Clin Pract. 100:55–62. 2005. View Article : Google Scholar : PubMed/NCBI
13.	Muñoz M, Villar I and García-Erce JA: An update on iron physiology. World J Gastroenterol. 15:4617–4626. 2009.
14.	Pérez-García R, Martín-Malo A, Fort J, et al: Baseline characteristics of an incident haemodialysis population in Spain: results from ANSWER – a multicentre, prospective, observational cohort study. Nephrol Dial Transplant. 24:578–588. 2009.PubMed/NCBI
15.	Malyszko J and Mysliwiec M: Hepcidin in anemia and inflammation in chronic kidney disease. Kidney Blood Press Res. 30:15–30. 2007. View Article : Google Scholar
16.	Nakai S, Masakane I, Shigematsu T, et al: An overview of regular dialysis treatment in Japan (as of 31 December 2007). Ther Apher Dial. 13:457–504. 2009. View Article : Google Scholar : PubMed/NCBI
17.	Agarwal R, Rizkala AR, Bastani B, Kaskas MO, Leehey DJ and Besarab A: A randomized controlled trial of oral versus intravenous iron in chronic kidney disease. Am J Nephrol. 26:445–454. 2006. View Article : Google Scholar : PubMed/NCBI
18.	Boddy K, Lawson DH, Linton AL and Will G: Iron metabolism in patients with chronic renal failure. Clin Sci. 39:115–121. 1970.PubMed/NCBI
19.	Hezode C, Cazeneuve C, Coue O, et al: Liver iron accumulation in patients with chronic active hepatitis C: prevalence and role of hemochromatosis gene mutations and relationship with hepatic histological lesions. J Hepatol. 31:979–984. 1999. View Article : Google Scholar : PubMed/NCBI
20.	Lim PS, Wei YH, Yu YL and Kho B: Enhanced oxidative stress in haemodialysis patients receiving intravenous iron therapy. Nephrol Dial Transplant. 14:2680–2687. 1999. View Article : Google Scholar : PubMed/NCBI
21.	Nascimento MM, Suliman ME, Bruchfeld A, et al: The influence of hepatitis C and iron replacement therapy on plasma pentosidine levels in haemodialysis patients. Nephrol Dial Transplant. 19:3112–3116. 2004. View Article : Google Scholar : PubMed/NCBI
22.	Feldman HI, Santanna J, Guo W, et al: Iron administration and clinical outcomes in hemodialysis patients. J Am Soc Nephrol. 13:734–744. 2002.PubMed/NCBI
23.	Williams P and Griffiths E: Bacterial transferrin receptors – structure, function and contribution to virulence. Med Microbiol Immunol. 181:301–322. 1992.
24.	Patruta SI, Edlinger R, Sunder-Plassmann G and Hörl WH: Neutrophil impairment associated with iron therapy in hemodialysis patients with functional iron deficiency. J Am Soc Nephrol. 9:655–663. 1998.PubMed/NCBI
25.	Lonnemann G, Krautzig S and Koch KM: Quality of water and dialysate in haemodialysis. Nephrol Dial Transplant. 11:946–949. 1996. View Article : Google Scholar : PubMed/NCBI