NN&I - April 2010
Patient Management 26 Nephrology News & Issues April 2010www.nephronline.com tered in a regular, low-dose regimen to hemodialysis patients with serum ferri -tin levels up to 1,200 ng/mL resulted in a reduced overall IV iron requirement while maintaining Hb and TSAT levels within recommended target ranges.1,9 This approach to IV iron management also reduced the mean weekly ESA dosage necessary to maintain these Hb and TSAT targets, indicating an improved erythropoietic response.Our study sought to investigate out -comes using a patient population with serum ferrtin levels similar to those in DRIVE, and the results for these out -comes are highly supportive of those in DRIVE. In the DRIVE studies, par -ticipants with serum ferritin levels >800 ng/mL were as likely as those with lower serum ferritin levels to respond to IV ferric gluconate.6 In a subsequent analysis of predictors of response to IV iron in the DRIVE study population, the only strong predictor of a positive response was a reticulocyte hemoglobin content (CHr) level \03731.2 pg/cell. The serum ferritin level, TSAT level, soluble transferrin receptor ratio, and increas -ing ESA dose were all poor predictors of response to IV iron. These results, as with the results of our study, emphasize the limitations of using so-called "high" serum ferritin levels to guide decision-making with IV iron therapy.10Concerns that have been raised over the use of IV iron in patients with ele-vated serum ferritin levels are based on the rationale that higher serum ferritin levels are indicators of iron overload and that excessive use of exogenous iron may expose the hemodialysis patient to unnecessary health risks stemming from iron's potential to mediate oxida -tive cellular damage. A low serum fer -ritin level (e.g.,<200 ng/mL) does appear to be a reliable marker for iron deficien -cy.1 However, it does not necessarily fol -low that an elevated serum ferritin is an indicator of excess iron. This is because serum ferritin is at best an indirect marker of body iron stores, and a num-Figure 1C-D. Scatterplot diagrams showing the mean HB level and the mean TSAT that is based on 15 hemodialysis patients with data available in 2007 and 2008. Each symbol type is a particular patient. The X-axis in each diagram represents 2007 data, while the Y-axis represents 2008 data. Forty-five-degree reference lines are included. 2007 Mean Hb, g/dL2008 Mean Hb, g/dLFigure 1C12.511 .5 12.0 12.5 13.0 13.512.0 11.5 11.0 2007 Mean TSA T, %2008 Mean TSAT , %Figure 1D4530 20 40 50 6035 40 25 30 20 Figure 1C Figure 1D[ P A TIENT MANAGEMENT , continued on page 29 ] Patient Management_0410_8.indd 26 3/19/10 2:07:01 PM
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