Predictors of the response to treatment in anemic hemodialysis patients with high serum ferritin and low transferrin saturation

• Published in: Kidney international Vol. 71; no. 11; pp. 1163 - 1171
• Main Authors: Singh, A.K., Coyne, D.W., Shapiro, W., Rizkala, A.R., the DRIVE Study Group
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2007; Nature Publishing; Elsevier Limited
• Subjects: Adult; African Americans - statistics & numerical data; Aged; Anemia, Iron-Deficiency - drug therapy; Anemia, Iron-Deficiency - etiology; Anemias. Hemoglobinopathies; Asian Continental Ancestry Group - statistics & numerical data; Biological and medical sciences; Diseases of red blood cells; epoetin; European Continental Ancestry Group - statistics & numerical data; Female; ferric gluconate; ferritin; Ferritins - blood; Hematinics - administration & dosage; Hematinics - therapeutic use; Hematocrit; Hematologic and hematopoietic diseases; Hemoglobins - drug effects; Hispanic Americans - statistics & numerical data; Humans; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Predictive Value of Tests; Renal Dialysis; response predictors; reticulocyte hemoglobin content; Transferrin - metabolism; transferrin saturation; Treatment Outcome; transferrin saturation; epoetin; ferric gluconate; ferritin; reticulocyte hemoglobin content; response predictors; High; Human; Transferrin; Nephrology; Prognosis; Anemia; Hemodialysis; Treatment efficiency; Saturation; Ferritin; Hemopathy; Urology; Extrarenal dialysis; Low; Hemoglobin; Serum; Reticulocyte; Predictive factor
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/sj.ki.5002223

Treating hemodialysis patients to combat anemia corrects hemoglobin but exacerbates iron deficiency by utilizing iron stores. Patients needing iron should receive this by intravenous (i.v.) means. The Dialysis patients’ Response to IV iron with Elevated ferritin (DRIVE) trial investigated the role of i.v. iron in anemic patients with high ferritin, low transferrin saturation, and adequate epoetin doses. We examined whether baseline iron and inflammation markers predict the response of hemoglobin to treatment. Patients (134) were randomized to no added iron or to i.v. ferric gluconate for eight consecutive hemodialysis sessions spanning 6 weeks with epoetin increased by 25% in both groups. The patients started with hemoglobin less than or equal to 11g/dl, ferritin between 500 and 1200ng/ml, and transferrin saturation of less than 25%. Significantly, patients with a reticulocyte hemoglobin content greater than or equal to 31.2pg were over five times more likely to achieve a clinically significant increase in hemoglobin of greater than 2g/dl. Lower reticulocyte hemoglobin contents did not preclude a response to i.v. iron. Significantly higher transferrin saturation or lower C-reactive protein but not ferritin or soluble transferrin receptor levels predicted a greater response; however their influence was not clinically significant in either group. We conclude that none of the studied markers is a good predictor of response to anemia treatment in this patient sub-population.