Treating Anemia in Dialysis Patients
Hemodialysis patients lose up to 5-7 mg of iron during each dialysis treatment, which is a primary contributor to their anemia. There is also an increased need for their iron level to be maintained to maximize response to ESA. Because oral iron supplementation generally is ineffective due to noncompliance and gastrointestinal adverse effects, most dialysis patients receive intravenous (IV) iron to help maintain sufficient iron stores. However, IV iron is stored in the liver, causing toxicity, and is also dosed infrequently, which can impede the ESA’s ability to be fully utilized.
Generally, ESRD patients need to be given erythropoiesis-stimulating agent (ESA) and IV iron together to achieve the most optimal hemoglobin level. The majority of patients on hemodialysis receive an ESA dose intravenously during each dialysis treatment. Intravenous (IV) iron however, tends to be dosed infrequently, usually once every 1-2 weeks. Infrequent dosing can be a problem for the patient because if there is an insufficient amount of iron present when an ESA is dosed there will be inadequate red blood cell generation and the ESA benefit will be compromised, and consequently more ESA will then need to be given. Continuous iron delivery that avoids the liver and travels directly to the blood stream should maintain optimal iron balance, providing a safer and more effective method of delivering iron while maximizing the benefit of ESA dosing. Note: The United States Food and Drug Administration (FDA) recently announced new findings and revised drug labeling that pertains to all currently marketed products in the class of ESAs, which should lead to more judicious dosing of ESAs. These findings include higher mortality, higher incidence of thrombotic-vascular events, and more rapid tumor progression in certain patients receiving ESAs.
NOTICE: Information presented above is not intended to be medical advice or recommendations. Please consult a health professional (doctor or nurse) about specific conditions or treatment pertaining to the kidneys.