Intravenous Iron Therapy in Peritoneal Dialysis Patients: Short-Term Efficacy and Long-Term Issues

Abstract Background: Anemia is common among ortho-geriatric hip fracture patients and is associated with prolonged recovery and increased postoperative mortality rate. Intravenous iron seems to increase hemoglobin recovery and reduce the mortality rate in patients undergoing orthopedic surgeries. This study investigated the association between short-term mortality risk and intravenous iron therapy in older patients undergoing hip fracture surgery.Methods: This observational study included 210 patients undergoing hip fracture surgery from July 2018 to Maj 2020. These 210 patients were alive and had a hemoglobin ≤ 6.5mmol/L on the 3rd postoperative day. In May 2019 a local intravenous iron therapy protocol was implemented and recommended intravenous iron (Monofer ©) if hemoglobin on the 3rd postoperative day was ≤ 6.5 mmol/L. According to treatment of postoperative anemia between 1st and 3rd day post-surgery, the patients were divided into four groups: No treatment (n=52), blood transfusion (n=38), IV Monofer (n=80) and blood transfusion & IV Monofer (n=40). Primary outcome was 30-day mortality post-surgery. The secondary outcome was the impact on hemoglobin level 14-30 days postoperatively. Multivariable Cox regression was used to estimate the 30-day mortality standardized for covariates. Results: Of 210 patients, 17 (8.1%) died within 30-days after surgery. There was a significantly lower mortality among the patients who received IV Monofer compared to those who received no treatment (HR: 0.17, 95% CI: [0.03-0.93], P = 0.041). Among the 86 patients with available hemoglobin measurements within 14 to 30 days post-surgery, there was no significant difference in hemoglobin level between the various treatment groups (mean 6.6 mmol/L, P = 0.1165).Conclusion: IV Monofer on the 3rd postoperative day in older hip fracture patients seemed to reduce 30-day mortality compared with no treatment. No significant differences in hemoglobin levels between 14-30 days post-surgery across treatment groups were found, although this was assessed in a subset of patients with available hemoglobin levels warranting further study. Trial registration: NA

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SHORT-TERM OUTCOME OF INTRAVENOUS IRON THERAPY FOR IRON DEFICIENCY ANAEMIA AT JNIMS, IMPHAL- A PRELIMINARY REPORT

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2018/616 ◽

2018 ◽

Vol 7 (23) ◽

pp. 2728-2731

Author(s):

Ginzaniang T ◽

Irom Anil Singh ◽

Ch. Arunkumar Singh ◽

Vedanti Devi P ◽

Kh. Yoihenba Kh. Yoihenba ◽

...

Keyword(s):

Iron Deficiency ◽

Preliminary Report ◽

Iron Deficiency Anaemia ◽

Intravenous Iron ◽

Iron Therapy ◽

Short Term ◽

Term Outcome ◽

Deficiency Anaemia ◽

Short Term Outcome ◽

Intravenous Iron Therapy

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Long-Term Prognosis of Hyperferritinemia Induced by Intravenous Iron Therapy in Patients Undergoing Maintenance Hemodialysis: A 10-Year, Single-Center Study

International Journal of Nephrology ◽

10.1155/2020/8864400 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Sayako Maeda ◽

Ryo Konishi ◽

Takuya Morinishi ◽

Yoko Shimizu ◽

Haruomi Nishio ◽

...

Keyword(s):

Ferritin Level ◽

Intravenous Iron ◽

Hemodialysis Patients ◽

Iron Therapy ◽

Maintenance Hemodialysis ◽

Risk Of Death ◽

Single Center Study ◽

Long Term Prognosis ◽

Intravenous Iron Therapy

Optimal ferritin level in hemodialysis patients between Japan and other countries is controversial. Long-term side effects of iron supplementation in these patients remain unclear. We aimed to elucidate whether past hyperferritinemia in hemodialysis patients was associated with high risk of death and cerebrovascular and cardiovascular diseases (CCVDs). This small retrospective cohort study included approximately 44 patients unintentionally supplemented with excessive intravenous iron. A significantly higher risk of CCVDs was observed in patients with initial serum ferritin levels ≥1000 ng/mL than in the remaining patients. High ferritin levels slowly decreased to <300 ng/mL in a median of 24.2 (10.5–46.5) months without treatment. However, compared with the remaining patients, only patients whose ferritin levels did not decrease to <300 ng/mL steadily had a significantly higher risk of all-cause death (hazard ratio, 9.6). Long-term hyperferritinemia due to intravenous iron therapy is a risk factor for death in maintenance hemodialysis patients. For a prolonged better prognosis, intravenous iron should be carefully administered so as to avoid hyperferritinemia in patients with hemodialysis.

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A metabolomics approach for predicting the response to intravenous iron therapy in peritoneal dialysis patients with anemia

RSC Advances ◽

10.1039/c6ra24152b ◽

2017 ◽

Vol 7 (4) ◽

pp. 1915-1922 ◽

Cited By ~ 1

Author(s):

Qiong Wu ◽

Xue-li Lai ◽

Hong-xia Zhao ◽

Zhen-yu Zhu ◽

Zhan-ying Hong ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

End Stage Renal Disease ◽

Intravenous Iron ◽

Dialysis Patients ◽

Receive Treatment ◽

Intravenous Iron Therapy ◽

Stage Renal Disease ◽

End Stage

Anemia is an almost universal complication of chronic kidney disease (CKD), and nearly all patients with end-stage renal disease (ESRD) and approximately 70% of those with earlier stages of CKD receive treatment for anemia.

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Is long-term intravenous iron therapy risky?

Renal Anemia ◽

10.1007/978-94-015-9998-6_12 ◽

2002 ◽

pp. 115-121

Author(s):

Wendy L. St. Peter

Keyword(s):

Intravenous Iron ◽

Iron Therapy ◽

Intravenous Iron Therapy

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Sa1164 PREOPERATIVE INTRAVENOUS IRON THERAPY AND SURVIVAL AFTER COLORECTAL CANCER SURGERY: LONG TERM RESULTS FROM THE INTRAVENOUS IRON IN COLORECTAL CANCER-ASSOCIATED ANAEMIA (IVICA) TRIAL.

Gastroenterology ◽

10.1016/s0016-5085(20)31436-0 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-296

Author(s):

Edward Dickson ◽

Barrie D. Keeler ◽

Oliver Ng ◽

Aditi Kumar ◽

Matthew Brookes ◽

...

Keyword(s):

Colorectal Cancer ◽

Intravenous Iron ◽

Cancer Surgery ◽

Iron Therapy ◽

Long Term Results ◽

Colorectal Cancer Surgery ◽

Intravenous Iron Therapy

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The effect of intravenous iron therapy on long-term survival in anaemic colorectal cancer patients: Results from a matched cohort study

Surgical Oncology ◽

10.1016/j.suronc.2018.03.005 ◽

2018 ◽

Vol 27 (2) ◽

pp. 192-199 ◽

Cited By ~ 3

Author(s):

M.J. Wilson ◽

J.W.T. Dekker ◽

S. Buettner ◽

J.J. Harlaar ◽

J. Jeekel ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Cancer Patients ◽

Intravenous Iron ◽

Iron Therapy ◽

Matched Cohort ◽

Term Survival ◽

Intravenous Iron Therapy ◽

Colorectal Cancer Patients

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Efficacy of bolus intravenous iron treatment in peritoneal dialysis patients

Medicinski pregled ◽

10.2298/mpns0502063j ◽

2005 ◽

Vol 58 (1-2) ◽

pp. 63-67 ◽

Cited By ~ 2

Author(s):

Natasa Jovanovic ◽

Mirjana Lausevic ◽

Vidosava Nesic ◽

Gordana Grujic-Adanja ◽

Biljana Stojimirovic

Keyword(s):

Peritoneal Dialysis ◽

Side Effects ◽

Blood Count ◽

Iron Supplementation ◽

Intravenous Iron ◽

Iron Therapy ◽

Chronic Peritoneal Dialysis ◽

Number Of Patients ◽

Intravenous Iron Therapy

Introduction. Normocytic, normochromic anemia is one of the first signs of chronic renal failure and it is common in patients on chronic dialysis treatment. It causes decrease in oxygen supply to tissues, increases cardiac minute volume, causes left ventricular hyperthrophy, cardiac insufficiency, disorders related to cognitive functions and immune response, and increases morbidity and mortality rates. The leading cause of anemia in patients on chronic peritoneal dialysis (PD) is iron depletion and most patients on PD need oral or parenteral iron supplementation. The aim of this study was to evaluate our first experience with bolus intravenous ferrogluconate therapy in patients on chronic peritoneal dialysis at the Nephrology Clinic of the Clinical Center of Serbia (CCS). Material and Methods. We examined 11 patients, 7 males and 4 females, mean-age 49 years (range 31 to 68 years) on chronic PD. All patients received blood transfusions, oral or intramuscular iron supplementation before 465 to 665 mg ferrogluconate therapy was given in 500 ml. saline intravenous infusion; 5 of them were on erythropoietin therapy and 2 of them started with EPO therapy after the ferrogluconate therapy. Results. The blood count improved during the first 3 months after application of bolus intravenous iron therapy (ferrogluconate); erythropoietin dose was not increased during the follow-up. Some patients suffered from side effects during infusion and 6 patients received the complete treatment. Discussion. Blood count improves in a number of patients affected by end-stage renal disease during the first months on continuous ambulatory peritoneal dialysis (CAPD) treatment. But a large number of patients on chronic CAPD treatment are iron-depleted and they require oral or parenteral substitution. Side effects and complications of intravenous iron therapy were not severe and only one patient suffered from allergic manifestations. Ferremia and blood count improved in patients who did not receive erythropoietin during the follow-up, and patients on erythropoietin therapy required lower doses after receiving the intraveonous iron therapy. Conclusion. Blood count improvement and the lack of severe side effects speak in favor of further iron supplementation with bolus intravenous iron replacement. .

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