P LEUNG1, D LANGSFORD1, 2
1Department of Nephrology, Northern Health, Melbourne, Victoria; 2University of Melbourne, Melbourne
Aim: To determine whether a new protocol results in improved iron stores, haemoglobin stability and reduced erythropoietin-stimulating agents (ESA) use.
Background: It is recognised that haemodialysis patients require iron replacement in conjunction with ESA to manage anaemia. However, the balance of iron replacement and ESA dosing is not well described. We describe the impact of an iron protocol using transferrin saturation (TSAT) to evaluate iron repletion and ferritin to assess iron overload. Previously we used iron dosing based on gender, haemoglobin (Hb) and ferritin alone. We hypothesised this would result in increased use of iron, reduced use of ESA and improved Hb stability.
Methods: A retrospective observational study of 59 chronic haemodialysis patients (26 female, mean age 70.6) was conducted. Hb, TSAT, ferritin, iron and ESA doses were collected for six months before and after the protocol change on 1 December 2015. ESA dosing was physician determined.
Results: The mean iron dose/patient increased over 6 months (644mg v.981mg; p<0.001). The mean ferritin was 293μg/L at pre-3-6 months and 422μg/L at post-3-6 months (p<0.001). There was no significant change in TSAT (21.6% v. 22.9%; p=0.162). The mean Hb over the pre-6 months was 109.1±14.2g/L, then 110.6 ±14.5g/L at month 4 post (p=0.253), 111.7±14.3g/L at month 5 (p=0.052) and 112.7±14.5g/L at month 6 (p=0.008). The mean darbepoietin dose over pre- 6 months was 109μg per month/patient and reduced to 108μg at month 4 post, 95μg month 5 and 92μg month 6 (not statistically significant). The cost saving was $46.83 per month/person.
Conclusions: Increased iron replacement is associated with significant Hb and ferritin elevations, reduced ESA and reduced overall cost of managing anaemia in haemodialysis patients.