Anaemia in chronic kidney disease pregnancy

Aim To review the incidence and management of anaemia and outcomes in pregnancies in a cohort of Australian women with chronic kidney disease. Methods A retrospective audit of 63 pregnancies in 52 women with chronic kidney disease. Results Sixty-eight percent of chronic kidney disease pregnancies were complicated by haemoglobin less than 100 g/L. Iron stores were measured in only 62% of all pregnancies. Serum ferritin was less than 100 ng/ml in 95% of those tested. Erythropoietin-stimulating agents were used in 24 pregnancies (38%). Intravenous iron was used in only nine non-dialysis pregnancies. Conclusion Greater awareness of the importance of regular measurement of iron stores and appropriate levels for repletion in chronic kidney disease pregnancies amongst health professionals involved in obstetric care may result in earlier detection and treatment of iron deficiency, and potentially improve maternal and fetal outcomes.

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A REVIEW ON COMPARITIVE STUDY ON SAFETY AND EFFECTIVENESS OF IV FERRIC CARBOXY MALTOSE VERSUS IRON SUCROSE IN PATIENTS WITH IRON DEFICIENCY ANAEMIA OF CKD

International Journal of Pharmaceutical and Biological Science Archive ◽

10.32553/ijpba.v7i2.123 ◽

2019 ◽

Vol 7 (2) ◽

Author(s):

LAYANA V. S ◽

RANI MANJU ◽

MATHEW GEORGE ◽

LINCY JOSEPH

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Intravenous Iron ◽

Iron Sucrose ◽

Deficiency Anemia ◽

Deficiency Anaemia ◽

Body Iron ◽

Iron Stores

Deficiency of iron is one of the most common nutritional disorders in the society. Iron deficiency anemia is described as decreased production in red blood cells (RBCs) due to low body iron stores.Anemia commonly occurs in people with chronic kidney disease and it might begin to develop in the early stages and tends to worsen as disease progresses. Iron supplementation is mandatory in the majority of patients with renal disease, particularly in those receiving ESA therapy. Treatment with intravenous iron in some clinical situations could present some advantages over oral iron, such as faster and higher increases of hemoglobin (Hb) levels and body iron stores. Some modern formulations of intravenous iron have emerged as a safe and effective alternative for iron deficiency anaemia management. E.g.: iron sucrose. Ferric carboxy maltose is a parenteral iron dextran-free product and the first of the new agents approved for rapid and high-dose replenishment of depleted iron stores. Keywords: Iron deficiency anaemia, chronic kidney disease, hemoglobin, iron sucrose, ferric carboxy maltose

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Anemia and iron deficiency among chronic kidney disease Stages 3–5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated

Clinical Kidney Journal ◽

10.1093/ckj/sfz091 ◽

2019 ◽

Vol 13 (4) ◽

pp. 613-624 ◽

Cited By ~ 8

Author(s):

Michelle M Y Wong ◽

Charlotte Tu ◽

Yun Li ◽

Rachel L Perlman ◽

Roberto Pecoits-Filho ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Management Practices ◽

Practice Patterns ◽

Intravenous Iron ◽

Cross Sectional ◽

Disease Outcomes ◽

The Usa ◽

Hemoglobin Measurement

Abstract Background International variation in anemia assessment and management practices in chronic kidney disease (CKD) is poorly understood. Methods We performed a cross-sectional analysis of anemia laboratory monitoring, prevalence and management in the prospective Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). A total of 6766 participants with CKD Stages 3a–5ND from nephrology clinics in Brazil, France, Germany and the USA were included. Results Among patients with anemia (hemoglobin <12 g/dL), 36–58% in Brazil, the USA and Germany had repeat hemoglobin measured and 40–61% had iron indices measured within 3 months of the index hemoglobin measurement. Anemia was more common in the USA and Brazil than in France and Germany across CKD stages. Higher ferritin and lower iron saturation (TSAT) levels were observed with lower hemoglobin levels, and higher ferritin with more advanced CKD. The proportion of anemic patients with ferritin <100 ng/mL or TSAT <20% ranged from 42% in Brazil to 53% in France and Germany, and of these patients, over 40% in Brazil, Germany and the USA, compared with 27% in France, were treated with oral or intravenous iron within 3 months after hemoglobin measurement. The proportion of patients with hemoglobin <10 g/dL treated with erythropoiesis-stimulating agents ranged from 28% in the USA to 57% in Germany. Conclusions Hemoglobin and iron stores are measured less frequently than per guidelines. Among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care.

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NIMO-CKD-UK: a real-world, observational study of iron isomaltoside in patients with iron deficiency anaemia and chronic kidney disease

BMC Nephrology ◽

10.1186/s12882-020-02180-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Philip A. Kalra ◽

Sunil Bhandari ◽

Michael Spyridon ◽

Rachel Davison ◽

Sarah Lawman ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Observational Study ◽

Adverse Drug Reactions ◽

Real World ◽

Iron Deficiency Anaemia ◽

Intravenous Iron ◽

Drug Reactions ◽

Deficiency Anaemia

Abstract Background Intravenous iron is often used to treat iron deficiency anaemia in non-dialysis chronic kidney disease (ND-CKD), but the optimal dosing regimen remains unclear. We evaluated the impact of high- versus low-dose intravenous iron isomaltoside on the probability of retreatment with intravenous iron in iron-deficient ND-CKD patients. Methods This real-world, prospective, observational study collected data from 256 ND-CKD patients treated for anaemia in the UK. Following an initial course of iron isomaltoside, patients were followed for ≥12 months. Iron dose and the need for retreatment were determined at the investigators’ discretion. The primary study outcome was the need for retreatment at 52 weeks compared between patients who received >1000 mg of iron during Course 1 and those who received ≤1000 mg. Safety was evaluated through adverse drug reactions. Results The probability of retreatment at Week 52 was significantly lower in the >1000 mg iron group (n = 58) versus the ≤1000 mg group (n = 198); hazard ratio (95% confidence interval [CI]): 0.46 (0.20, 0.91); p = 0.012. Mean (95% CI) haemoglobin increased by 6.58 (4.94, 8.21) g/L in the ≤1000 mg group and by 10.59 (7.52, 13.66) g/L in the >1000 mg group (p = 0.024). Changes in other blood and iron parameters were not significantly different between the two groups. Administering >1000 mg of iron isomaltoside saved 8.6 appointments per 100 patients compared to ≤1000 mg. No serious adverse drug reactions were reported. Of the patients who received ≤1000 mg of iron in this study, 82.3% were eligible for a dose >1000 mg. Conclusions The >1000 mg iron isomaltoside regimen reduced the probability of retreatment, achieved a greater haemoglobin response irrespective of erythropoiesis-stimulating agent treatment, and reduced the total number of appointments required, compared to the ≤1000 mg regimen. Many of the patients who received ≤1000 mg of iron were eligible for >1000 mg, indicating that there was considerable underdosing in this study. Trial registration ClinicalTrials.gov NCT02546154, 10 September 2015.

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SP348A COMPARATIVE HEALTHCARE COST ANALYSIS OF PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE AND IRON DEFICIENCY/ANEMIA TREATED WITH ORAL OR INTRAVENOUS IRON USING A GERMAN CLAIMS DATABASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz103.sp348 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Kathrin Borchert ◽

Kim-Sarah Krinke ◽

Sandra Wächter ◽

Simona Gavata-Steiger ◽

Jennifer Haas ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Cost Analysis ◽

Iron Deficiency Anemia ◽

Healthcare Cost ◽

Intravenous Iron ◽

Deficiency Anemia ◽

Claims Database

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Iron Deficiency Anemia in Chronic Kidney Disease

Acta Haematologica ◽

10.1159/000496492 ◽

2019 ◽

Vol 142 (1) ◽

pp. 44-50 ◽

Cited By ~ 13

Author(s):

Anat Gafter-Gvili ◽

Amir Schechter ◽

Benaya Rozen-Zvi

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Iron Supplementation ◽

Deficiency Anemia ◽

Functional Iron Deficiency ◽

Iron Stores ◽

Ckd Stage ◽

Absolute Iron Deficiency

Iron deficiency anemia is a common complication of chronic kidney disease (CKD). CKD patients suffer from both absolute and functional iron deficiency. Absolute iron deficiency is defined by severely reduced or absent iron stores, while functional iron deficiency is defined by adequate iron stores but insufficient iron availability for incorporation into erythroid precursors. This is due to increased levels of hepcidin. Anemia in CKD is associated with an increased risk of morbidity and mortality. The association between anemia and mortality may be related to the severity of anemia. All CKD patients should be screened for anemia during the initial evaluation for CKD. Criteria used to define iron deficiency are different among CKD compared to normal renal function. Among CKD patients, absolute iron deficiency is defined when the transferrin saturation (TSAT) is ≤20% and the serum ferritin concentration is ≤100 ng/mL among predialysis and peritoneal dialysis patients or ≤200 ng/mL among hemodialysis patients. Functional iron deficiency, also known as iron-restricted erythropoiesis, is characterized by TSAT ≤20% and elevated ferritin levels. Iron supplementation is recommended for all CKD patients with anemia. There is general agreement according to guidelines that intravenous (i.v.) iron supplementation is the preferred method for CKD patients on dialysis (CKD stage 5D) and either i.v. or oral iron is recommended for patients with CKD ND (CKD stages 3–5). In this review we discuss the evidence base for these recommendations.

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