4 YEARS FOLLOW UP AFTER THE INTRODUCTION OF A PROACTIVE HIGH-DOSE IRON THERAPY PROTOCOL: A SINGLE-CENTRE AUDIT
Rosy Wang1, Keshani Jayaweera1, Lauren Heath1, Emma O’Lone1 1Department Of Renal Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
Abstract
Aim: To investigate iron and erythropoietin-stimulating agent (ESA) usage in relation to haemoglobin, iron studies and CRP in haemodialysis patients 4 years after the implementation of a proactive high-dose iron protocol.
Background: The PIVOTAL trial in 2018 demonstrated that high-dose iron administration in haemodialysis patients was non-inferior to low-dose iron for cardiovascular outcomes and mortality without increasing adverse events. In 2019, our centre implemented a proactive high-dose iron protocol which reduced ESA dosing over 1 year. This audit is 4 years post-implementation.
Methods: Data collected included demographics, cumulative iron and ESA dosing, haemoglobin, iron studies and CRP from December 2022 to February 2023 in haemodialysis patients. Analysis was performed using t-test and Mann-Whitney U test for parametric and non-parametric data respectively.
Results: The 2023 haemodialysis cohort (n=98, Aranesp® 64%, Mircera® 23%) was compared to 2019 (n=108) and 2018 (n=108). ESA dosing was lower in 2023 relative to 2018 (median Aranesp® dose 360mcg vs. 500mcg, p=0.006). Compared to 2018, cumulative iron dosing increased in both 2019 (median 300mg vs. 400mg, p=0.02) and 2013 (median 300mg vs. 400mg, p=0.02). Mean ferritin levels were significantly elevated in 2023 compared to 2019 (736mcg/L vs. 561mcg/L, p=0.006) and 2018 (736mcg/L vs. 506mcg/L, p=0.001) without associated changes in haemoglobin (114g/L vs. 113g/L vs. 112g/L, p>0.05) or CRP (10.7mg/L vs. 17.1mg/L vs. 13.5mg/L, p>0.05).
Conclusions: A proactive iron protocol has successfully reduced EPO dosing with no significant increase in CRP. High ferritin levels have been associated with increased mortality and there is no long-term data on the safety of proactive iron administration as median follow up in PIVOTAL was 2.1 years. This audit will prompt re-evaluation of this protocol in our department.
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