Predictors of the response to treatment in anemic hemodialysis patients with high serum ferritin and low transferrin saturation

Kidney Int. 2007 Jun;71(11):1163-71. doi: 10.1038/sj.ki.5002223. Epub 2007 Mar 28.

Abstract

Treating hemodialysis patients to combat anemia corrects hemoglobin but exacerbates iron deficiency by utilizing iron stores. Patients needing iron should receive this by intravenous (i.v.) means. The Dialysis patients' Response to IV iron with Elevated ferritin (DRIVE) trial investigated the role of i.v. iron in anemic patients with high ferritin, low transferrin saturation, and adequate epoetin doses. We examined whether baseline iron and inflammation markers predict the response of hemoglobin to treatment. Patients (134) were randomized to no added iron or to i.v. ferric gluconate for eight consecutive hemodialysis sessions spanning 6 weeks with epoetin increased by 25% in both groups. The patients started with hemoglobin less than or equal to 11 g/dl, ferritin between 500 and 1200 ng/ml, and transferrin saturation of less than 25%. Significantly, patients with a reticulocyte hemoglobin content greater than or equal to 31.2 pg were over five times more likely to achieve a clinically significant increase in hemoglobin of greater than 2 g/dl. Lower reticulocyte hemoglobin contents did not preclude a response to i.v. iron. Significantly higher transferrin saturation or lower C-reactive protein but not ferritin or soluble transferrin receptor levels predicted a greater response; however their influence was not clinically significant in either group. We conclude that none of the studied markers is a good predictor of response to anemia treatment in this patient sub-population.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Anemia, Iron-Deficiency / drug therapy*
  • Anemia, Iron-Deficiency / etiology
  • Asian Continental Ancestry Group / statistics & numerical data
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Ferritins / blood*
  • Hematinics / administration & dosage
  • Hematinics / therapeutic use*
  • Hematocrit
  • Hemoglobins / drug effects
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Renal Dialysis*
  • Transferrin / metabolism*
  • Treatment Outcome

Substances

  • Hematinics
  • Hemoglobins
  • Transferrin
  • Ferritins