TY - JOUR
T1 - Economic appraisal of maintenance patenteral iron administration in treatment of anaemia in chronic haemodialysis patients
AU - Sepandj, F.
AU - Jindal, K.
AU - West, M.
AU - Hirsch, D.
PY - 1996/2
Y1 - 1996/2
N2 - Background. Iron deficiency is common in haemodialysis patients and adequate supplementation by the oral or patenteral route has been limited by drug side-effects, absorption, and cost. Intermittent doses of intravenous iron dextran complex are recommended in patients with inadequate iron stores despite maximal tolerated oral dose. We conducted a prospective study with economic analysis of a regular maintenance intravenous iron regimen in this group of patients. Methods. Fifty patients comprising one-half of our haemodialysis population required intravenous iron treatment, i.e. they failed to achieve an arbitrary goal serum ferritin 100 ug/l despite maximal tolerated oral iron dose. After a loading dose of intravenous iron dextran complex (IV-FeD) based on Van Wyck's nomogram (400 + 300 mg) they received a maintenance dose of 100 mg IV-FeD once every 2 weeks. Initial goal serum ferritin was set at 100-200 μg/l. If no increase in haemoglobin was achieved at this level, transferrin saturation was measured to assess bioavailable iron, and when less than 20%, goal serum ferritin was increased to 200-300 μg/l. Recombinant human erythropoietin (rHuEpo) was used where needed to maintain haemoglobin in the 9.5-10.5 g/l range only if ferritin requirements were met. Results. Mean haemoglobin rose from 87.7 ± 12.1 to 100.3 ± 13.1 g/l (P < 0.001. Cl 7.7-17.9) at mean follow-up of 6 months (range 3-15 months). In patients on rHuEpo, dose per patient was reduced from 96 ± 59 u/kg per week to 63 ± 41 u/kg per week, representing a 35% dose reduction (P < 0.05, Cl 1-65). An annual cost reduction of S3166 CDN was projected; however, in the first year this is offset by the cost of the loading dose of IV-FeD required at the beginning of treatment. No adverse reactions were encountered. Conclusion. Iron deficiency is very common in our haemodialysis population, especially in those patients receiving rHuEpo. A carefully monitored regimen of maintenance parenteral iron is a safe, effective, and economically favourable means of iron supplementation in patients with insufficient iron stores on maximum tolerated oral supplements.
AB - Background. Iron deficiency is common in haemodialysis patients and adequate supplementation by the oral or patenteral route has been limited by drug side-effects, absorption, and cost. Intermittent doses of intravenous iron dextran complex are recommended in patients with inadequate iron stores despite maximal tolerated oral dose. We conducted a prospective study with economic analysis of a regular maintenance intravenous iron regimen in this group of patients. Methods. Fifty patients comprising one-half of our haemodialysis population required intravenous iron treatment, i.e. they failed to achieve an arbitrary goal serum ferritin 100 ug/l despite maximal tolerated oral iron dose. After a loading dose of intravenous iron dextran complex (IV-FeD) based on Van Wyck's nomogram (400 + 300 mg) they received a maintenance dose of 100 mg IV-FeD once every 2 weeks. Initial goal serum ferritin was set at 100-200 μg/l. If no increase in haemoglobin was achieved at this level, transferrin saturation was measured to assess bioavailable iron, and when less than 20%, goal serum ferritin was increased to 200-300 μg/l. Recombinant human erythropoietin (rHuEpo) was used where needed to maintain haemoglobin in the 9.5-10.5 g/l range only if ferritin requirements were met. Results. Mean haemoglobin rose from 87.7 ± 12.1 to 100.3 ± 13.1 g/l (P < 0.001. Cl 7.7-17.9) at mean follow-up of 6 months (range 3-15 months). In patients on rHuEpo, dose per patient was reduced from 96 ± 59 u/kg per week to 63 ± 41 u/kg per week, representing a 35% dose reduction (P < 0.05, Cl 1-65). An annual cost reduction of S3166 CDN was projected; however, in the first year this is offset by the cost of the loading dose of IV-FeD required at the beginning of treatment. No adverse reactions were encountered. Conclusion. Iron deficiency is very common in our haemodialysis population, especially in those patients receiving rHuEpo. A carefully monitored regimen of maintenance parenteral iron is a safe, effective, and economically favourable means of iron supplementation in patients with insufficient iron stores on maximum tolerated oral supplements.
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U2 - 10.1093/oxfordjournals.ndt.a027260
DO - 10.1093/oxfordjournals.ndt.a027260
M3 - Article
C2 - 8671786
AN - SCOPUS:0030043814
SN - 0931-0509
VL - 11
SP - 319
EP - 322
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 2
ER -