The efficacy of iron dextran for the treatment of iron deficiency in hemodialysis patients.

We prospectively evaluated the efficacy of intravenous iron dextran for the replacement of iron stores in iron deficient hemodialysis patients. Twenty-eight patients with serum ferritin < 100 ng/ml were treated with 100 mg intravenous iron dextran for ten consecutive hemodialysis treatments. Therapy was considered successful if the serum ferritin remained > 100 ng/ml for 4 months after treatment. Mean hematocrit increased from 29.1 +/- 0.9% at baseline to 33.6 +/- 1.8% at ten weeks (p < 0.05). The mean erythropoietin dose decreased from 94.1 +/- 5.3 U/kg body weight per treatment at baseline to 82.6 +/- 4.4 U/kg body weight per treatment at 10 weeks (p < 0.05). The mean serum ferritin at baseline was 38.3 +/- 5.5 ng/ml, at 2 weeks 135.9 +/- 19.7 ng/ml, at 6 weeks 114.1 +/- 22.4 ng/ml, and 86.6 +/- 17.7 ng/ml at 10 weeks. The number of patients at the therapeutic target (serum ferritin > 100 ng/ml) was 13 of 28 at 2 weeks after therapy, 9 of 28 at 6 weeks, and 8 of 28 at 10 weeks. The initial serum ferritin was the variable most predictive of successful therapy. None of 15 patients with baseline serum ferritin less than 28 ng/ml had a serum ferritin > 100 ng/ml at 4 months, compared with 8 of 13 (61%) with initial ferritins > or = 28 ng/ml. Baseline hematocrit and transferrin saturation were not predictive of therapeutic success. In summary, this regimen for administration of intravenous iron dextran resulted in improved erythropoiesis, however, at study completion iron stores remained inadequate in the majority of patients. Baseline serum ferritin < 28 ng/ml was highly predictive of patients who failed to reach the therapeutic target.