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Intravenous Iron Supplementation and Chronic Kidney Disease

Intravenous Iron Supplementation and Chronic Kidney Disease. Chloe Bierbower December 2, 2013. Definition of Evidence-Based Medicine. Definition: The integration of individual clinical expertise and the best external evidence when deciding how to care for patients. Pro:

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Intravenous Iron Supplementation and Chronic Kidney Disease

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  1. Intravenous Iron Supplementation and Chronic Kidney Disease Chloe Bierbower December 2, 2013

  2. Definition of Evidence-Based Medicine • Definition: • The integration of individual clinical expertise and the best external evidence when deciding how to care for patients. • Pro: • Helps clinicians assess whether or not a treatment will help a patient or do more harm • Con: • Results from studies may not be relevant for all treatment situations and applications

  3. Non-Dialysis Chronic Kidney Disease and Iron Deficiency Anemia • Iron deficiency is a common cause of anemiain ND-CKD patients • Iron deficiency anemia inflicts patients with ND-CKD at all stages • Decreased kidney function caused by CKD can cause iron deficiency anemia by: • Erythropoietin deficiency • Decreased red blood cell synthesis • Decreased use of nutritional and stored iron

  4. Qunibi et al., 2010 • Studied the efficacy of IV Ferric Carboxymaltosevs Oral Ferrous Sulfate in treating iron deficiency anemia in ND-CKD patients • Methods • Open-label, randomized, controlled, multicenter trial (47 centers) • Subject criteria: • 12 years of age, GFR 45 mL/min, Hb 11 g/dL, TSAT 25%, ferritin 300 ng/mL • 147 people received FCM infusions of a maximum of 1000 mg over 15 mins • 103 received 325 mg of oral ferrous sulfate 1 hour before meals 3 times daily • Study conducted over 8 weeks

  5. Qunibi et al., 2010 • IV Ferric Carboxymaltose is more effective than Oral Ferrous Sulfate in treating iron deficiency anemia in ND-CKD patients • 134 from FCM group completed the study (91.2%) • 84 from oral group completed the study (81.6%) • Intravenous FCM was more effective at treating anemia than oral ferrous sulfate • FCM increased repletion of iron stores better and faster than oral ferrous sulfate • Proportion of a drug-related adverse effects lower in FCM group than oral group

  6. Qunibi et al., 2010

  7. Stancu et al., 2009 • Studied the response to IV iron sucrose supplementation in treating iron deficiency anemia in ND-CKD patients • Methods • 3 month-long single center diagnostic study • 2 months- admission criteria assessed • Baseline: bone marrow aspiration, TSAT, serum ferritin evaluated • Subject criteria: • Hb 11g/dL, Stages 3-5 CKD, GFR  60 mL/min • Excluded if have additional health conditions • 100 adults (<18) received 1000mg of iron sucrose intravenously 5 days after baseline • Returned 1 month later • Evaluated Hb, TSAT, serum ferritin levels

  8. Stancu et al., 2009 • IV iron supplementation can be useful in managing anemia in ND-CKD patients • 100% of patients completed study • Response defined as 1 g/dL increase in Hb • 49 responders, 51 nonresponders • Mean Hb attained was 10g/dL • 1.0.4 g/dL mean increase • Responders were younger and a greater proportion of them were in Stage 4 CKD • ~1/3 of responders showed iron-replete bone marrow stores

  9. Stancu et al., 2009

  10. Recommendation and Grades • Intravenous iron supplementation is beneficial for ND-CKD patients with iron deficiency anemia • Evidence • Qunibi et al. = A • Randomized controlled, multicenter trial • Short, no long term effects • Stancu et al. = C • Single-center, not randomized controlled • One of the largest studies, however, still relatively small sample size • Overall grade = B • Need more long-term studies • More evidence needed in type of IV iron used

  11. Bibliography • Stancu, S., Barsan, L., Stanciu, A., & Mircescu, G. (2009). Can the response to iron therapy be predicted in anemic nondialysis patients with chronic kidney disease?. Clinical Journal of the American Society of Nephrology, 5(3), 409-419. Retrieved from http://cjasn.asnjournals.org/content/5/3/409.full • Qunibi, W. Y., Martinez, C., Smith, M., Benjamin, J., Mangione, A., & Roger, S. (2010). A randomized controlled trial comparing intravenous ferric carboxymaltose with oral iron for treatment of iron deficiency anaemia of non-dialysis-dependent chronic kidney disease patients. Nephrology Dialysis Transplantation, 26(5), 1599-1607. Retrieved from http://ndt.oxfordjournals.org/content/26/5/1599.short • Van Wyck, D. B., Roppolo, M., Martinez, C. O., Mazey, R. M., & McMurray, S. (2005). A randomized, controlled trial comparing IV iron sucrose to oral iron in anemic patients with nondialysis-dependent CKD. Kidney International, 68(6), 2846-2856. doi:10.1111/j.1523-1755.2005.00758.x

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