Nephrology and Dialysis Unit, Papardo Hospital, 98158 Messina, Italy.
Department of Economics, University of Messina, 98100 Messina, Italy.
Medicina (Kaunas). 2023 Jun 2;59(6):1071. doi: 10.3390/medicina59061071.
Iron deficiency and anemia characterize patients on chronic hemodialysis (HD). Available intravenous iron agents, such as ferric gluconate (FG) and ferric carboxymaltose (FCM), vary in dosing regimens and safety profiles. The aim of the present study was to analyze the modification of the iron status, the correction of anemia, and the economic implications after the shift from FG to FCM therapy in chronic HD patients. We evaluated, during the study, the variations in iron metabolism, assessing ferritin and transferrin saturation, erythropoietin-stimulating agent (ESA) doses and the number of administrations, the effects on anemic status, and consequent costs. A retrospective study was performed with a follow-up period of 24 months, enrolling forty-two HD patients. The enrolment phase started in January 2015, when patients were treated with iv FG, and continued until December 2015, when FG was discontinued, and, after a wash-out period, the same patients were treated with FCM. The iron switch reduced the administered dose of ESA by 1610.500 UI (31% of reduction; < 0.001) during the entire study period and reduced the erythropoietin resistance index (ERI) (10.1 ± 0.4 vs. 14.8 ± 0.5; < 0.0001). The FCM group had the highest percentage of patients who did not require ESA treatment during the study period. The FCM patients were characterized by higher levels of iron ( = 0.04), ferritin ( < 0.001), and TSAT levels ( < 0.001) compared to the FG patients. The annual cost during FG infusion was estimated at EUR 105,390.2, while one year of treatment with FCM had a total cost of EUR 84,180.7 (a difference of EUR 21,209.51 (20%), saving EUR 42.1 per patient/month ( < 0.0001). FCM was a more effective treatment option than FG, reducing ESA dose requirements, increasing Hb levels, and improving iron status. The reduced ESA doses and the decreased number of patients needing ESA were the main factors for reducing overall costs.
缺铁和贫血是慢性血液透析（HD）患者的特征。可用的静脉铁剂，如葡萄糖酸铁（FG）和羧基麦芽糖铁（FCM），在剂量方案和安全性方面有所不同。本研究的目的是分析从 FG 转换为 FCM 治疗后，慢性 HD 患者的铁状态、贫血纠正情况和经济影响。在研究过程中，我们评估了铁代谢的变化，评估了铁蛋白和转铁蛋白饱和度、促红细胞生成素刺激剂（ESA）的剂量和给药次数、对贫血状态的影响以及相应的成本。这是一项回顾性研究，随访时间为 24 个月，共纳入 42 名 HD 患者。登记阶段于 2015 年 1 月开始，当时患者接受静脉 FG 治疗，并持续到 2015 年 12 月，FG 停止使用，在洗脱期后，相同的患者接受 FCM 治疗。铁剂转换使整个研究期间 ESA 的给药剂量减少了 1610.500 UI（减少 31%；<0.001），并降低了红细胞生成素抵抗指数（ERI）（10.1±0.4 与 14.8±0.5；<0.0001）。FCM 组在研究期间无需 ESA 治疗的患者比例最高。与 FG 组相比，FCM 组的铁（=0.04）、铁蛋白（<0.001）和转铁蛋白饱和度（<0.001）水平更高。FG 输注期间的年费用估计为 105390.2 欧元，而 FCM 治疗一年的总费用为 84180.7 欧元（差异为 21209.51 欧元（20%），每位患者每月节省 42.1 欧元（<0.0001）。FCM 是一种比 FG 更有效的治疗选择，可降低 ESA 剂量需求，提高 Hb 水平，改善铁状态。ESA 剂量减少和需要 ESA 的患者数量减少是降低总费用的主要因素。
