Intravenous iron requirement in adult hemodialysis patients

Objective. Chronic hemodialysis patients often require maintenance intravenous iron, as iron is an essential component of effective erythropoiesis. The Anemia Work Group (NKF-K/DOQI) anemia guidelines suggest a maintenance intravenous iron dose of 25-125 mg, but the optimal maintenance dose regimen remains difficult to determine. K/DOQI recommends these iron parameters: TSAT >= 20 % and <50%, ferritin >= 100 and <800 ng/mL. An assessment of the maintenance dose regimen used in the present study is presented in this article. Patients and Methods. Data were collected retrospectively to evaluate clinical response in 40 adult chronic hemodialysis patients who received regular maintenance intravenous iron sucrose of 100 mg either every other week or every fourth week based on their ferritin and transferrin saturation (TSAT) levels. If ferritin level was between 100 and 500 ng/mL and TSAT level was 20 % and 30 %, then iron sucrose was administered every other week; if ferritin was 500-700 ng/mL, or TSAT was 30 % - 45%, then iron sucrose was administered every fourth week. Ferritin and TSAT levels were monitored quarterly. Results. After the first quarter, 15 (38 %) of the patients (n = 15) remained on their original dosing regimen; 21 (53 %) patients required adjustment to their regimen, either by discontinuing the regimen (n = 18) or decreasing the dosing interval (n = 3), 45% and 7.5% respectively; and 4 (10 %) patients required additional intravenous iron supplementation. Conclusions. Iron sucrose administered at a dosage of 100 mg on a maintenance regimen either every other week or every fourth week exceeded most patients' requirements. Maximum intravenous iron maintenance doses for adult chronic hemodialysis patients remain difficult to determine, and the maintenance iron requirement varies from patient to patient.