Nephrol Dial Transplant (2001) 16: 1879-1884
© 2001 European Renal Association-European Dialysis and Transplant Association
A prospective crossover trial comparing intermittent intravenous and continuous oral iron supplements in peritoneal dialysis patients
Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia
Background. Concomitant iron supplementation is required in the great majority of erythropoietin (Epo)-treated patients with end-stage renal failure. Intravenous (i.v.) iron supplementation has been demonstrated to be superior to oral iron therapy in Epo-treated haemodialysis patients, but comparative data in iron-replete peritoneal dialysis (PD) patients are lacking.
Methods. A 12-month, prospective, crossover trial comparing oral and i.v. iron supplementation was conducted in all Princess Alexandra Hospital PD patients who were on a stable dose of Epo, had no identifiable cause of impaired haemopoiesis other than uraemia, and had normal iron stores (transferrin saturation >20% and serum ferritin 100–500 mg/l). Patients received daily oral iron supplements (210 mg elemental iron per day) for 4 months followed by intermittent, outpatient i.v. iron infusions (200 mg every 2 months) for 4 months, followed by a further 4 months of oral iron. Haemoglobin levels and body iron stores were measured monthly.
Results. Twenty-eight individuals were entered into the study and 16 patients completed 12 months of follow-up. Using repeated-measures analysis of variance, haemoglobin concentrations increased significantly during the i.v. phase (108±3 to 114±3 g/l) compared with each of the oral phases (109±3 to 108±3 g/l and 114±3 to 107±4 g/l, P<0.05). Similar patterns were seen for both percentage transferrin saturation (23.8±2.3 to 30.8±3.0%, 24.8±2.1 to 23.8±2.3%, and 30.8±3.0 to 26.8±2.1%, respectively, P<0.05) and ferritin (385±47 to 544±103 mg/l, 317±46 to 385±47 mg/l, 544±103 to 463±50 mg/l, respectively, P=0.10). No significant changes in Epo dosages were observed throughout the study. I.v. iron supplementation was associated with a much lower incidence of gastrointestinal disturbances (11 vs 46%, P<0.05), but exceeded the cost of oral iron treatment by 6.5-fold.
Conclusions. Two-monthly i.v. iron infusions represent a practical alternative to oral iron and can be safely administered to PD patients in an outpatient setting. Compared with daily oral therapy, 2-monthly i.v. iron supplementation in PD patients was better tolerated and resulted in superior haemoglobin levels and body iron stores.
Keywords: erythropoietin; ferritin; haemoglobins; iron economics; peritoneal dialysis; prospective studies
Correspondence and offprint requests to: Dr D. W. Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Q 4102, Australia.
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