Switching iron sucrose to ferric carboxymaltose associates to better control of iron status in hemodialysis patients

• Main Authors: Jesse M. G. Hofman, Michele F. Eisenga, Adry Diepenbroek, Ilja M. Nolte, Bastiaan van Dam, Ralf Westerhuis, Stephan J. L. Bakker, Casper F. M. Franssen, Carlo A. J. M. Gaillard
• Format: Article
• Language: English
• Published: BMC 2018-09-01
• Series: BMC Nephrology
• Subjects: Ferric carboxymaltose; Iron sucrose; Hemodialysis; Iron status; ESA
• Online Access: http://link.springer.com/article/10.1186/s12882-018-1045-8

Abstract Background Although the efficacy of iron sucrose (IS) and ferric carboxymaltose (FCM) in treating anemia in hemodialysis (HD) patients has been studied individually, a comparison of these two intravenous iron formulations has not yet been performed in HD patients. Methods We performed a retrospective audit on records of 221 stable HD patients from different HD centers in the Netherlands, who were switched from IS to FCM on a 1:1 ratio. To assess the effect of the switch on iron status parameters, data from 3 time points before and 3 time points after the switch were analyzed using linear mixed effects models. Subanalyses were done in 2 subgroups of patients anemic or iron deficient at baseline. Results Hemoglobin increased in all groups (anemic [1.4 g/dL, P < 0.001] iron deficient [0.6 g/dL, P < 0.001]), while the weekly iron dose was significantly lower when patients received FCM compared to IS (48 vs 55 mg/week, P = 0.04). Furthermore, serum ferritin and transferrin saturation increased in all groups (anemic [64 μg/L, 5.0%, P < 0.001] iron deficient [76 μg/L, 3.6%, P < 0.001]). Finally, the darbepoetin α dose decreased significantly in all groups (anemic [− 16 μg/wk., P = 0.01] iron deficient [− 11 μg/wk., P < 0.001]). Conclusions In this real-life study in HD patients, a switch from IS to FCM resulted in an improvement of iron status parameters despite a lower weekly dose of FCM. Furthermore, the ESA dose was reduced during FCM, while hemoglobin levels increased.