Effects of Iron Anemia Treatment in Chronic Renal Failure Patients Undergoing Hemodialysis at Yasothon Hospital

Abstract

Background: Anemia in CKD is a common problem especially patients receiving hemodialysis.The condition
is a major risk factor for morbidity and mortality. Iron deficiency is the leading cause in patients who remain
anemia even after receiving hematopoietic drugs and intravenous iron has been found to increase blood
concentrations. Reduce the amount of injectable blood stimulating drugs in chronic renal failure patients
undergoing hemodialysis. However, the indications for iron administration, as well as the administration of
dosing, also differ from country to country. This study was conducted to determine the effect of intravenous
iron on anemia, dose, hemopoietic stimulation, and cost of treatment in chronic renal failure patients
undergoing hemodialysis.
Objective: To study the incidence of iron deficiency anemia in chronic renal failure patients undergoing
regular hemodialysis in Yasothon Hospital and study the effectiveness of treatment for iron deficiency
anemia in patients with chronic renal failure by intravenous iron.
Study style: Prospective analytic studies/Cohort studies)
Methods: The population group was chronic renal failure patients undergoing hemodialysis in Yasothon
Hospital with anemia admitted to hemodialysis clinic from May 1, 2022 to October 31, 2022, randomized
study in chronic renal failure patients undergoing hemodialysis from the Hemodialysis Center. They were
randomly divided into two groups: 1) those requiring a serum ferritin level of 200-400 ng/ml and 2) a group
requiring a serum ferritin level of 500-700 ng/ml. There was an 8-week trial period. In those requiring serum
ferritin levels of 500-700 ng/ml, 100 mg of iron was administered weekly for 6 weeks (600 mg total) to have
a serum ferritin level of 500-700 ng/ml prior to the follow-up phase while in the group requiring a serum
ferritin level of 200-400 ng/ml, which was considered a control group, would not receive iron due to serum
ferritin levels of 200-400 ng/ml at the start of the study. After that, treatment was followed every 3 months
for 6 months, with changes in iron levels (Serum ferritin, Serum iron, Total iron binding capacity (TIBC),
Transferrin saturation) blood concentrations and the amount of drug to stimulate blood cell formation.
Results: A total of 588 patients received a blood test for screening prior to their participation in the study.
360 patients were excluded because they did not meet the diagnostic criteria. 228 eligible patients were randomly assigned to the study group, of which 114 were enrolled. 114 patients were randomly assigned
to the blood ferritin group maintained at 200-400 ng/ml and 114 were randomly assigned to the 500-700
ng/ml serum ferritin group. There were no significant differences in the baseline data of the two groups of
patients. The results showed that the concentration of blood cells the amount of iron accumulated in the
body, the numberof blood-stimulating drugs. The doses of iron given at baseline at 3 months and 6 months
were significantly different. (Hb 9.4±1.4 g/dl Hematopoietic dose 7,105.1±2,279.1 unit/week in the serum
ferritin level of 200-400 ng/ml compared with Hb 10.0±1.7 g/dl of the blood stimulating drug dose
6,262.5±2,467.0 unit/week in the serum ferritin level of 500-700 ng/ml at the time of study) (Hb 8.9±1.3 g/dl
Hematopoietic dose 7,331.2±2,118.1 unit/week in the blood ferritin group at 200-400 ng/ml compared to
Hb 9.8±1.8 g/dl. Dosage of blood stimulating drug 6,347.1±2,663.1 unit/week in the blood ferritin group at
500-700 ng/ml at baseline) (Hb 9.0±1.3 g/dl Iron dosage 318.8±78.8 g/3 months 6,946.6±1,837.1 unit/week
in the blood ferritin group at 200-400 ng/ml compared to Hb 9.8±1.6 g/dl. Dosage of iron 595.3±216.1 g/3
months. 6,587.4±2,956.1 unit/week in the blood ferritin group at 500-700 ng/ml at 3 months) (Hb 9.4±1.4
g/dl in the serum ferritin level of 200-400 ng/ml compared with Hb 10.1±1.4 g/dl in the blood ferritin level
of 500-700 ng/ml at 6 months). When analyzed for percentage change in each group, there was no
statistically significant difference in change at 3 months post-dose (Hb 2.8±13.0% vs Hb 1.6±15.1%, P=0.625,
Hematopoietic dose -1.9±16% vs 8.1±30.4%, p=0.099). Conclusion, Parenteral iron to maintain ferritin levels
at 200-400 ng/ml and 500-700 ng/ml can maintain blood concentration. There was no difference in the
number of hematopoietic injections. While those receiving parenteral iron to maintain ferritin levels of 200-
400 ng/ml, the average iron dose was about 100 mg per month. The group receiving intravenous iron to
maintain ferritin levels of 500-700 ng/ml received an average of about 200 mg of iron per month. It is
believed that in patients undergoing hemodialysis, continuous iron administration is likely to be required to
maintain blood concentrations and serum iron levels. According to this study, patients should be receiving
at least 100 mg of intravenous iron per month.
Conclusion: Studies suggest that patients undergoing hemodialysis should require continuous iron therapy
to maintain blood concentrations and serum iron levels. According to this study, patients should be receiving
at least 100 mg of intravenous iron per month.