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Ferric Gluconate Reduces Epoetin Requirements in Hemodialysis Patients with Elevated Ferritin

Toros Kapoian^*, Neeta B. O'Mara, Ajay K. Singh, John Moran, Adel R. Rizkala^||, Robert Geronemus^¶, Robert C. Kopelman^**, Naomi V. Dahl^|| and Daniel W. Coyne

^* Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, Department of Pharmacy, Dialysis Clinic, Inc, North Brunswick, New Jersey, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, Satellite Healthcare, Inc, Mountain View, California, ^|| Clinical Affairs, Watson Laboratories, Inc, Morristown, New Jersey, ^¶ South Florida Nephrology Associates, Ft. Lauderdale, Florida, ^** Bakersfield Dialysis Center, Bakersfield, California, and Department of Medicine, Washington University, St. Louis, Missouri

Correspondence: Dr. Toros Kapoian, UMDNJ-Robert Wood Johnson Medical School, Department of Medicine/Nephrology, 1 Robert Wood Johnson Place, MEB-412B, New Brunswick, NJ 08903. Phone: 732-235-4453; Fax: 732-235-6124; E-mail: tkapoian{at}verizon.net

Received for publication May 24, 2007. Accepted for publication September 17, 2007.

The Dialysis Patients Response to IV Iron with Elevated Ferritin (DRIVE) study demonstrated the efficacy of intravenous ferric gluconate to improve hemoglobin levels in anemic hemodialysis patients who were receiving adequate epoetin doses and who had ferritin levels between 500 and 1200 ng/ml and transferrin saturation (TSAT) 25%. The DRIVE-II study reported here was a 6-wk observational extension designed to investigate how ferric gluconate impacted epoetin dosage after DRIVE. During DRIVE-II, treating nephrologists and anemia managers adjusted doses of epoetin and intravenous iron as clinically indicated. By the end of observation, patients in the ferric gluconate group required significantly less epoetin than their DRIVE dose (mean change of –7527 ± 18,021 IU/wk, P = 0.003), whereas the epoetin dose essentially did not change for patients in the control group (mean change of 649 ± 19,987 IU/wk, P = 0.809). Mean hemoglobin, TSAT, and serum ferritin levels remained higher in the ferric gluconate group than in the control group (P = 0.062, P < 0.001, and P = 0.014, respectively). Over the entire 12-wk study period (DRIVE plus DRIVE-II), the control group experienced significantly more serious adverse events than the ferric gluconate group (incidence rate ratio = 1.73, P = 0.041). In conclusion, ferric gluconate maintains hemoglobin and allows lower epoetin doses in anemic hemodialysis patients with low TSAT and ferritin levels up to 1200 ng/ml.

This article has been cited by other articles:

				M. Rambod, C. P. Kovesdy, and K. Kalantar-Zadeh Combined High Serum Ferritin and Low Iron Saturation in Hemodialysis Patients: The Role of Inflammation Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1691 - 1701. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673