P86
EFFICACY AND SAFETY PROFILE OF SINGLE DOSE INTRAVENOUS FERRIC
CARBOXYMALTOSE IN THE MANAGEMENT OF RENAL ANAEMIA – A SINGLE
CENTRE EXPERIENCE
Exarchou, K, Tanahill, N, Anthoney, A, Khalil, A, Ahmed, S
Renal Unit, Royal Liverpool University Hospital, Liverpool
INTRODUCTION: Anaemia is a known complication of advanced chronic kidney disease
(CKD). In recent years, there has been a growing interest in optimizing iron management for the
treatment of renal anaemia, in order to reduce the high cost of erythrocyte stimulating agents
(ESAs) in comparison to iron therapy. Furthermore a significant portion of pre dialysis CKD
patients may not require ESAs to achieve optimum Haemoglobin (Hb) levels and iron therapy is
undertaken as the primary treatment of anaemia [1]. Intravenous (IV) iron sucrose (IS) is the
agent of choice in most hospitals for the treatment of renal anaemia. However, IS must be
administered over 5 doses requiring multiple hospital or clinic visits. As a suitable alternative,
we introduce Ferric carboxymaltose (FC) as a single dose agent for the treatment (Rx) of
chronic anaemia with multiple advantages including reduced hospital visits, patient satisfaction
and cost effectiveness. In addition, a 6 month audit was undertaken to review its efficacy and
safety.
METHOD: We modified our local renal anaemia management policy according to NICE CKD
guidelines (CG114) using single dose IV FC. All cases that were classed as CKD renal anaemia
received IV FC were included in this audit over a 6 month period. The cohort also included
patients on ESAs. Data was collected prospectively, including pre and post haemoglobin (6
weeks post IV FC Rx), iron studies and clinical information regarding pre and post blood
pressure (BP) monitoring and adverse effects.
RESULTS: A total of 245 patients with renal anaemia (not on dialysis) were identified and
results obtained pre and post IV FC infusion. Among them, 42% of patients were on ESAs.
Mean age 71(24-95) with M: F ratio 119:126. There is a mean increase of Hb level > 1 gm/dl
with single dose IV FC (mean Hb 10.1g/dl vs. Hb 11.3g/dl post treatment).There was also a
significant improvement of the iron profile (Table 1). Median BP pre 144/78mmHg and post
133/74mmHg dose. In patients on ESAs (n=104), 26% (1in 4) either had their ESA dose
reduced or stopped following IV FC infusion. Only 17% (n=41) of the total patient cohort
required 2nd dose of IV FC as did not achieve the targeted iron profile. No reported incidence
of any serious adverse effect.
Table1: Pre and Post treatment (Rx) Hb and Iron profile with IV FC
Hb(g/dl)
Serum iron (umol/l) % Iron saturation Ferritin(ugm/l)
Pre Rx ( mean)
10.1
7.86
15.33
170.32
Post Rx ( mean)
11.3
12.03
26.92
480.37
CONCLUSION: Single-dose IV FC was associated with significant improvements in Hb and
iron profile and is clinically safe. Other positive outcomes were fewer hospital visits, reduced
interruption in lifestyle and improved patient experience. Furthermore, single dose IV iron
replacement with FC has been associated with reduced ESA usage and therefore, overall cost
efficient.
References:
1. Besarab A, Coyne DW. Iron supplementation to treat anemia in patients with chronic kidney
disease. Nat Rev Nephrol. 2010 Dec;6(12):699-710.