Intravenous iron supplementation for the treatment of anaemia in pre-dialyzed chronic renal failure patients

Background. Intravenous iron is a recognized therapy of anaemia in chronic haemodialyzed patients, especially in those receiving erythropoietin (Epo), while its role in the anaemia of pre-dialyzed chronic renal failure (CRF) patients is much less clear. This study attempted to evaluate the effects of intravenous iron in anaemic pre-dialyzed patients. Methods. Sixty anaemic (haemoglobin < 11 g/dl) non-diabetic patients with moderate CRF [32 males, 28 females; mean age 52.2 +/- 12.5 years; mean glomerular filtration rate 36.2 +/- 5.2 ml/min], without iron deficiency, iron overload or inflammation, without concomitant erythropoietin treatment and without any previous iron therapy were enrolled. Intravenous iron was administered as iron sucrose, 200 mg elemental iron per month for 12 months, with 1 month pre-study survey and 1 month follow-up after the last iron dose. Results. Intravenous iron supplementation was associated with a significant increase in haemoglobin (from 9.7 +/- 1.1 at the baseline to 11.3 +/- 2.5 g/dl after 12 months, a mean increase of 1.6 g/dl), a further 36% of patients reaching the target haemoglobin of 10 g/dl. There was a significant increase in serum iron from 73.9 +/- 17.2 to 101.8 +/- 12.2 mu g/dl, in serum ferritin from 98.0 (24.8-139.0) to 442.5 (86.0-496.0) mu g/l and in transferrin saturation from 21.6 +/- 2.6 to 33.6 +/- 3.2%. No worsening of renal function, no increase in blood pressure and no other side effects were noted. Conclusions. Intravenous iron therapy in pre-dialysis patients with no Epo seems often to ameliorate the anaemia, avoiding the necessity of Epo or blood transfusions in one-third of pre-dialyzed non-diabetic patients. Intravenous iron supplementation appears to be an effective and safe treatment for anaemia in pre-dialysis CRF patients.