Results of an anemia management program to reduce high epoetin doses by targeted use of i.v. ferric gluconate.

Intravenous (i.v.) iron and erythropoiesis-stimulating agents (ESAs) are important therapies in the management of anemia in patients on hemodialysis. However, there is a consensus that ESAs need to be used judiciously--a result of mounting evidence reporting increased risks when targeting higher hemoglobin (Hb) levels with higher ESA doses. Adding i.v. iron to an ESA regimen can be a cost-effective strategy to improve Hb levels and reduce ESA doses, as observed in the Dialysis Patients' Response to i.v. Iron with Elevated Ferritin (DRIVE) study. In the authors' dialysis facility, lessons learned from DRIVE were applied to the facility's anemia management program. An i.v. iron-loading dose of 500 mg to 1,000 mg of sodium ferric gluconate for patients on hemodialysis receiving at least 18,000 units/week of Epoetin, had a serum ferritin less than 1,500 ng/mL and a transferrin saturation (TSAT) less than 30%, and had not received a loading dose of i.v. iron in the previous 6 months was considered As a result, it was observed that a 1 gram course of ferric gluconate appears to be a cost-effective way to improve Hb and TSAT levels and reduce Epoetin doses, without a significant increase in serum ferritin.