Dr Rachel Elliott1, Mrs Patricia Margetts1, Dr Lee Skeat1, Dr Steven Yew1, Dr Geoff Kirkland1, Doctor Richard Yu1, Mrs Danielle Watson1, Mrs Kathleen Branton1, Doctor Evelyn Perry1, Doctor Hilary Hiscock1, Doctor Henry Guo1, Mrs Win Lynd1, A/Professor Matthew Jose1
1Royal Hobart Hospital, Hobart, Australia
Biography:
Bio to come
Aim:
To evaluate six months of a nurse-led proactive iron protocol, based on the PIVOTAL trial, with a focus on anaemia, erythropoietin (EPO) dosing, and hospital admissions.
Background:
The PIVOTAL trial demonstrated improved all-cause mortality and reduced EPO use with proactive iron therapy. KDIGO guidelines recommend iron supplementation in anaemic patients with ferritin <500 µg/L and transferrin saturation (TSAT) <30%. A nurse-led protocol was developed administering monthly 400 mg iron sucrose to patients with haemoglobin (Hb) <120 g/L, ferritin <700 µg/L, and TSAT <40%, aiming to improve outcomes and reduce EPO requirements.
Methods:
All patients receiving EPO were assessed monthly for ferritin, TSAT, and Hb. Iron was administered if ferritin <700 µg/L and TSAT <40%, unless Hb exceeded 120 g/L. Continued iron use beyond three months prompted medical review. Baseline and six-month data on Hb, ferritin, TSAT, EPO dosing, and hospital admissions were analysed.
Results:
Median monthly iron dosing was 267 mg, comparable to PIVOTAL’s 264 mg. Patients with Hb <100 g/L decreased from 13 to 11; those with Hb >119 g/L increased from 8 to 9. Mean ferritin rose by 194.2 µg/L (median: 398 to 618 µg/L). TSAT increased by 0.6%. Median EPO dose declined from 7000 to 6000 units/week. EPO dosing was unchanged in 29 patients; reduced in 15; increased in 11. Hospital admissions rose slightly (56 to 57), with increases in infection (10 to 14) likely seasonal. There was also a small increase to presentations with heart failure (5 to 7), and coronary artery disease (2 to 4)
Conclusion:
At six months, the impact on EPO dosing is inconclusive. Further data at 12 and 24 months will better inform outcomes.