NN&I - April 2010
Patient Management www.nephronline.comApril 2010 Nephrology News & Issues 23The DRIVE results showed that IV ferric gluconate improved a number of outcomes in patients with higher serum ferritin levels. Hb levels increased after the initial six weeks of DRIVE in the IV ferric gluconate group compared with the control group (10.3 to 11.9 g/ dL vs 10.1 to 11.4 g/dL, respectively), and these benefits were maintained over the course of DRIVE-II.6 TSAT lev-els were similarly increased during the six-week DRIVE period in the IV fer-ric gluconate group versus the control group (18.2% to 25.9% vs. 19.1% to 21%, respectively), with these improvements also maintained in DRIVE-II. By the end of DRIVE-II, patients in the IV ferric gluconate group required lower ESA doses compared with their initial DRIVE dose (a mean reduction of 7,527 IU per week). In comparison, ESA doses were unchanged in the control group (a mean increase of 649 IU per week). The improvement in responsive-ness to ESAs was statistically significant (P=.017).6 Factoring the decrease in ESA requirements into a cost analysis, the use of IV ferric gluconate resulted in a cost savings of $1,390 per g/dL increase in Hb.8No significant differences in serum ferritin levels were seen in the IV fer- ric gluconate group compared with the control group at the end of DRIVE-II. In addition, treatment during DRIVE and DRIVE-II had little impact on increas-ing the number of patients in higher serum ferritin ranges (ie, >800 ng/mL).6The improvements in Hb and TSAT, and the reductions in ESA requirements, were independent of the patients' ini-tial serum ferritin levels, meaning that those patients with higher serum ferri-tin levels (>800 ng/mL) were as likely to experience improvement with IV ferric gluconate as those with serum ferritin levels <800 ng/mL.6 These findings of DRIVE and DRIVE-II are significant because many hemodialysis providers withhold IV iron therapy at serum fer- ritin levels >500 ng/mL or >800 ng/mL. We sought to apply the findings of DRIVE in a hemodialysis facility set-ting by examining the use of IV fer-ric gluconate in a patient population with serum ferritin levels similar to the DRIVE population. Study Methods This was a retrospective, multi-center study designed to determine if weekly IV iron therapy administered at serum ferritin levels up to 1,200 ng/mL improved anemia outcomes. The study was conducted at two separate sites in the Boise Kidney and Hypertension Institute, which is associated with the Liberty Dialysis network. The study comprised two, 12-month observation periods in 2007 and 2008. Patients were included in the analysis if they had documented Hb, TSAT, albu- Patient Management_0410_7.indd 23 3/18/10 3:44:51 PM
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