Poll results from last week's question regarding anemia management in the dialysis patient. Interestingly, there was a fairly strong consensus on this one, with over 75% of individuals electing to give a course of iv iron to the dialysis patient in question, who was anemic despite relatively large EPO doses and a ferritin level of 900.
The relevant trials to cite here are the DRIVE and DRIVE-II trials, in which anemic dialysis patients with an elevated serum ferritin (between 500-1220 ng/ml) and low transferrin saturation (less than 25%) were randomized to receive either a course of iv iron or not. After 6 weeks, individuals in the iron group were found to have greater hemoglobin levels than the control group, with no obvious differences in complications between the two groups. While this result would seemingly indicate that "giving a course of iv iron" would be the correct choice, there are still some reasonable doubters out there. For instance, this CJASN editorial by Drs. Spiegel and Chertow rationally point out that "the long-term safety of unbridled IV iron administration has never been established." Although we may find it distasteful as physicians wanted to do something to help our patient correct their anemia, I think a compelling case could also be made for the first answer suggested in the poll--"continue current anemia management."
Be sure and check out the newest poll question in the right margin!