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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2002  |  Volume : 13  |  Issue : 2  |  Page : 131-140
Effect of Intravenous Iron Saccharate on the Requirements of Erythropoietin in Hemodialysis Patients

1 Jeddah Kidney Center, Riyadh, Saudi Arabia
2 Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

Correspondence Address:
Faissal AM Shaheen
Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 17660651

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We attempt in this study to evaluate the effect of intravenous iron saccharate (i.v. Sach) on the erythropoietin (EPO) requirements during the initial phase of replacement therapy with recombinant human erythropoietin (r-HuEPO) in adult chronic hemodialysis (HD) patients. We evaluated 96 study patients who completed 12 weeks of treatment with EPO. There were 69 (72%) males and 27 (28%) females with a mean age of 44 10 years (range 24 to74 years). The patients were initiated on EPO at 50 units/kg body weight subcutaneously post-dialysis two to three times weekly. Intravenous iron was administered to maintain the ferritin levels and transferrin saturation ratio within normal range. There were 36 (37.5%) patients who received i.v. Sach at doses of 100 mg at the end of dialysis two or three times per week during the whole study period (total dose 2400-3600 mg). Of the 96 study patients, 91 (94.8%) responded to the EPO. The mean hemoglobin (Hb) at entry to the study was 72 84 g/L (range 52-88 g/L). There was a significant increase of the mean Hb to 108 10 g/L (range 70-120 grams/L) at the end of the study (P<0.0001). The mean total weekly dose per kg per patient per week of EPO was 149 11 (range 100-225) units/kg/week and decreased significantly to 141 24 units/kg/week at the end of the study (P<0.0006). The study patients were stratified by the baseline ferritin and transferrin saturation (TSAT) into three sub-groups: group I: patients with TSAT <0.2 and ferritin <100 ng/ml; group II: patients with TSAT >0.2 and ferritin <100 ng/ml; group III: patients with TSAT >0.2 and ferritin >100 ng/ml. There were 19 patients in group I (13 received i.v. Sach), 26 in group II (16 received i.v. Sach) and 44 in group III (seven received i.v. Sach). There was a group of seven patients who had TSAT <0.2 and ferritin >100 ng/ml, however, none received i.v. Sach and they were not included in the stratification. There was no significant difference in the mean Hb between patients who received and those who did not receive i.v. Sach in the sub-groups studied. However, there was a significant decrease in the mean weekly dose of EPO in the patients who received i.v. Sach. We conclude that routine use of i.v. iron supplementation in chronic HD patients receiving recombinant EPO may be beneficial in the initial phase of treatment in attaining the target Hb with lower doses of EPO, regardless of the status of the iron indices.

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