Reduction of recombinant human erythropoietin maintenance dose by supplementation with a low-dose iron preparation, given intravenously

Background. In chronic hemodialysis patients who showed iron deficiency, we investigated whether the maintenance dose of recombinant human erythropoietin (rHuEPO) could be reduced by long-term intravenous supplementation with a low-dose iron preparation. Methods. In 26 chronic hemodialysis patients who were receiving treatment with a maintenance dose of rHuEPO, without an iron supplement, who showed iron deficiency, the intravenous administration of 40 mg of chondroitin sulfate-iron colloid once per week after dialysis was initiated. We observed the patients' course for 1 year and investigated the reduction in the rHuEPO dose. Results. In the 26 patients, the rHuEPO dose was reduced by 25% after 6 months, and the reduction increased to 32% in the twelfth month. The patients were divided, according to the maintenance dose of rHuEPO received before the iron supplementation into high-, intermediate-, and low-dose groups (9000, 4500, and 2250 IU/week, respectively), and the results were analyzed. A marked reduction of the rHuEPO dose, of 46% in the twelfth month, was obtained in the intermediate-dose group. In the high- and low-dose groups, the reductions of the rHuEPO dose were low. Conclusions. In chronic hemodialysis patients with iron deficiency who are being treated with a maintenance dose of rHuEPO, the intravenous administration of a low dose of iron (40 mg/week) led to a reduction in the rHuEPO dose. This effect was marked in patients in the intermediate-dose rHuEPO group, i.e., 4500 IU/week, which is the most frequently employed maintenance dose in Japan. This therapeutic method can be recommended from a health-care economics perspective. Received: April 5, 2001 / Accepted: August 22, 2001