The Influence of Need‐Based,Continuous, Low‐Dose Iron Replacement on Hemoglobin Levels in Hemodialysis Patients Treated With Erythropoiesis‐Stimulating Agents

Anemia is a common and important complication of chronic kidney disease. Treatment includes the use of erythropoiesis‐stimulating agents (ESAs) and iron supplementation. However, the optimal schedule of iron supplementation remains to be defined. Thirty‐one long‐term hemodialysis patients were treated for 1 year (period 1) with ESAs and an intermittent pulse regimen consisting of 100 mg of iron sucrose administered after different dialysis sessions depending on serum ferritin and other laboratory values, but no more than once per week. During the next 3 years (period 2), patients were treated with ESAs and need‐based, continuous, low‐dose iron. Iron doses were determined on the basis of values and changes of serum ferritin and transferrin saturation every fourth week after the longest interdialysis time interval. Iron doses ranged from 10 to 60 mg of iron sucrose and were given 1–3 times per week. If grounded, we gradually reduced or even abolished the iron doses. A significant increase in the hemoglobin concentration and hematocrit during period 2 in comparison with period 1 was observed. The use of ESAs did not change significantly during period 2 in comparison with period 1, while the use of iron was significantly lower in period 2. Significantly lower values were obtained for serum ferritin, saturation of transferrin, serum iron, and total serum iron‐binding capacity during period 2. A better response to ESA therapy (increase in hemoglobin and hematocrit) is achieved with need‐based, continuous, low‐dose iron replacement.