Dr Amanda Leong1
1Monash Health, , Australia
Biography:
Nephrology Advanced Trainee at Monash Medical Centre
Background:
Proactive intravenous (IV) iron therapy is associated with higher serum ferritin and transferrin concentrations, a faster rise in haemoglobin from baseline, lower cumulative doses of erythropoiesis stimulating agents (ESA) and lower risk of the primary cardiovascular events without any major increase in side effects
Aim:
This single centre study aimed to determine if the proactive intravenous iron therapy and its associated clinical outcomes in a clinical trial is translatable to similar patients on maintenance haemodialysis at Peninsula Health, Victoria.
Methods:
A proactive IV iron therapy protocol, based on the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) Trial, was implemented in November 2023 for 82 patients on maintenance haemodialysis. Iron status, haemoglobin levels, ESA dosing, and complications were analysed and compared to historical parameters in the same cohort of patients whilst they were receiving iron based on standard reactive iron protocol. A period of 12 months of standard reactive iron protocol was compared to 12 months of proactive iron infusion.
Results:
The study found no significant difference between the median haemoglobin levels and ESA dose. However, 6 out of 7 (86%) patients who had below target haemoglobin levels in the reactive iron phase achieved target haemoglobin levels in the proactive phase. Less patients (4.8% in the proactive phase versus 9.4% in the reactive phase) required blood transfusions during the proactive iron phase. There were however, increased incidences of hospitalizations from heart failure, vascular access thromboses and infection in the proactive iron infusion phase.
Conclusion:
These results suggest benefits in proactive iron infusion in achieving target haemoglobin levels in patients on maintenance haemodialysis