Continuous Versus Intermittent Intravenous Iron Administration In Haemodialysis Patients On Erythropoietin: A Randomised Controlled Study

Methods: This randomised controlled study was designed as a pilot study to compare the effi cacy and safety outcomes between a reactive protocol of intermittent bolus intravenous iron administration (RPIB) using Ferrum H boluses (200mg-1000mg) and a proactive protocol of continuous intravenous iron administration (PPCI) using the dialysis heparin pump to co-infuse 10mg Ferrum H per dialysis, in haemodialysis patients in a tertiary teaching Renal Unit with more than 300 dialysis patients Results: The PPCI achieved equivalent measured outcomes to RPIB. Fifty stable haemodialysis patients were randomised at a point of stable Hb, iron stores and erythropoietin (EPO) dose. At the end of six months, the total delivered iron dose was not statistically signifi cantly different, although PPCI tended to deliver more intravenous iron (PPCI 632.3+82.7mg vs RPIB 411.5+571.5mg/6months). PPCI (n=24) maintained an achieved Hb no different to RPIB (n=26) (PPCI 12.0+1.9 vs RPIB 12.1+1.2 (SD)). The EPO doses were not statistically signifi cantly different. However the EPO dose in PPCI group therapy fell progressively over the 6 months, resulting in a 12% reduction in median EPO dose, compared to the RPIB group which showed a small progressive rise, but this did not reach statistical signifi cance. Iron parameters were not different between the two groups at baseline or at six months although there was a trend to higher TSAT in participants receiving RPIB therapy, which did not reach statistical signifi cance (p=ns) at the end of six months. No participants had to cease RPIB for iron overload. Conclusion: PPCI therapy successfully maintained achieved Hb and iron parameters while allowing a small progressive reduction in EPO dose, compared to RPIB therapy, without the risk of iron overload. The administration of Ferrum H in the heparin infusion proved safe and no adverse reactions were detected (24 patients, > 1848 dialyses).