Nephrol Dial Transplant (2001) 16: 115-119
© 2001 European Renal Association-European Dialysis and Transplant Association
Intravenous iron for CAPD populations: proactive or reactive strategies?
Department of Renal Medicine, St James's University Hospital, Beckett St, Leeds, UK
Background. The European best practice guideline [Nephrol Dial Transplant 1999; 14 (Suppl 5)] (5A) for the management of anaemia suggests that >85% of the CAPD population should have a haemoglobin level of >11.0 g/dl.
Methods. We developed and implemented an outpatient-based protocol for intravenous iron sucrose (IV Fe) and erythropoietin (Epo) in CAPD patients showing iron deficiency despite oral iron therapy. We managed a total of 103 patients over 13 months of study. All CAPD patients were included, regardless of co-morbidity. Treatment developed in two phases: in phase 1 (reactive) (months 1–8), patients with markers of iron deficiency (ferritin <100 ng/ml or ferritin 100–500 and percentage hypochromic red cells (%HRC) 
5) were converted from oral iron to IV Fe (300 mg) and reviewed after 4–8 weeks according to haemoglobin (Hb). In phase 2 (proactive) (months 9–13), the criteria for iron therapy were extended: ferritin <150 ng/ml or ferritin 150–500 and %HRC 2. Patients then received IV Fe (200 mg) and were reviewed after 4 weeks according to Hb.
Results. The median haemoglobin increased from 11.0 (Inter quartile range, IQR, 10.1–12.6) g/dl to 11.7 (11.0–12.7) g/dl (P=0.06). The proportion of patients with absolute iron deficiency (ferritin <100 ng/ml) decreased from 24 to 2%. The percentage of hypochromic red cells (%HRC) decreased from 4 (2–7) to 1 (1–4) (P<0.01).
Conclusions.An integrated Epo and IV Fe policy increased the number of patients reaching the European guideline from 50 to 75% with no increase in the population median Epo requirements (42 (IQR, 25–95) IU/kg/week vs 45 (27–101) (P=NS)). This study demonstrates the benefit of early (proactive) intervention in achieving population compliance within current guidelines for renal anaemia.
Keywords: clinical governance; erythropoietin; haemoglobin; iron deficiency; iron sucrose; peritoneal dialysis
Correspondence and offprint requests to: Dr Donald Richardson, Renal Research Registrar, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Will Intention and outcome in guideline-based nephrological practice: a suitable space for 'clinical technology' Nephrol. Dial. Transplant., November 1, 2007; 22(11): 3110 - 3114. [Full Text] [PDF]
|
|
|
|
|
|
E. J. Will, D. Richardson, C. Tolman, and C. Bartlett Development and exploitation of a clinical decision support system for the management of renal anaemia Nephrol. Dial. Transplant., June 1, 2007; 22(suppl_4): iv31 - iv36. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Johnson INTRAVENOUS VERSUS ORAL IRON SUPPLEMENTATION IN PERITONEAL DIALYSIS PATIENTS Perit. Dial. Int., June 1, 2007; 27(Supplement_2): S255 - S260. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Singh, J. Reed, S. Noble, J. L. Cangiano, D. B. Van Wyck, and for the United States Iron Sucrose (Venofer) Clini Effect of Intravenous Iron Sucrose in Peritoneal Dialysis Patients Who Receive Erythropoiesis-Stimulating Agents for Anemia: A Randomized, Controlled Trial Clin. J. Am. Soc. Nephrol., May 1, 2006; 1(3): 475 - 482. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E J Will Aiming at averages J R Soc Med, January 12, 2001; 94(12): 617 - 619. [Full Text] [PDF]
|
|