Date Published: 
Wednesday, 6 August, 2014

Intravenous iron therapy combined with higher ferritin targets may reduce the need for additional anaemia management in patients with CKD

Intravenous ferric carboxymaltose and a higher ferritin target may delay or reduce the need for additional anaemia treatment compared with oral iron in chronic kidney disease (CKD). In addition, a greater proportion of patients achieve a faster haematological response and haemoglobin increase, researchers reveal.

The FIND-CKD study randomised 626 patients with non-dialysis dependent CKD to oral iron or intravenous ferric carboxymaltose, targeting two different ferritin level ranges (400–600 µg/L or 100–200 µg/L). The primary end point was time to initiation of other anaemia management ( erythropoiesis-stimulating agents [ESAs], other iron therapy or blood transfusion) or haemoglobin trigger (two consecutive values <10 g/dL on or after Week 8).

Anaemia management was initiated in 23.5, 32.2 and 31.8% of patients in the high-ferritin, low-ferritin and oral iron groups, respectively. The increase in haemoglobin was greater with a high ferritin target versus oral iron (p=0.014) and a greater proportion of patients achieved a haemoglobin increase of ≥1 g/dL with high-ferritin ferric carboxymaltose compared with oral iron (p<0.001). There was no significant difference between the high-ferritin and low-ferritin ferric carboxymaltose treatment arms (p=0.082).

Furthermore, high-ferritin ferric carboxymaltose was well tolerated, with fewer treatment-related adverse events and study discontinuations compared with oral iron. No renal toxicity or increases in cardiovascular or infectious events were observed.  

The authors conclude that using intravenous ferric carboxymaltose to target a higher ferritin range quickly reaches and maintains haemoglobin level, and delays or reduces the need for other anaemia management, including ESAs. They state that patients with non-dialysis-dependent CKD, anaemia and iron deficiency may benefit from intravenous iron therapy targeting a higher ferritin level.

The full article is available online ahead of print in Nephrology Dialysis Transplantation. For information on iron deficiency in chronic kidney disease, please click here.