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Optimal Serum Ferritin Levels for Iron Deficiency Anemia during Oral Iron Therapy (OIT) in Japanese Hemodialysis Patients with Minor Inflammation and Benefit of Intravenous Iron Therapy for OIT-Nonresponders

1
Department of Internal Medicine, Division of Nephrology, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan
2
Department of Nephrology, Kanazawa University; Kanazawa, Ishikawa 9208641, Japan
3
Department of Pediatrics, Public Central Hospital of Matto Ishikawa, Ishikawa 9248588, Japan
*
Authors to whom correspondence should be addressed.
Nutrients 2018, 10(4), 428; https://doi.org/10.3390/nu10040428
Received: 10 February 2018 / Revised: 13 March 2018 / Accepted: 19 March 2018 / Published: 29 March 2018
(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)
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Abstract

Background: We determined optimal serum ferritin for oral iron therapy (OIT) in hemodialysis (HD) patients with iron deficiency anemia (IDA)/minor inflammation, and benefit of intravenous iron therapy (IIT) for OIT-nonresponders. Methods: Inclusion criteria were IDA (Hb <120 g/L, serum ferritin <227.4 pmol/L). Exclusion criteria were inflammation (C-reactive protein (CRP) ≥ 5 mg/L), bleeding, or cancer. IIT was withheld >3 months before the study. ΔHb ≥ 20 g/L above baseline or maintaining target Hb (tHB; 120–130 g/L) was considered responsive. Fifty-one patients received OIT (ferrous fumarate, 50 mg/day) for 3 months; this continued in OIT-responders but was switched to IIT (saccharated ferric oxide, 40 mg/week) in OIT-nonresponders for 4 months. All received continuous erythropoietin receptor activator (CERA). Hb, ferritin, hepcidin-25, and CERA dose were measured. Results: Demographics before OIT were similar between OIT-responders and OIT-nonresponders except low Hb and high triglycerides in OIT-nonresponders. Thirty-nine were OIT-responders with reduced CERA dose. Hb rose with a peak at 5 months. Ferritin and hepcidin-25 continuously increased. Hb positively correlated with ferritin in OIT-responders (r = 0.913, p = 0.03) till 5 months after OIT. The correlation equation estimated optimal ferritin of 30–40 ng/mL using tHb (120–130 g/L). Seven OIT-nonresponders were IIT-responders. Conclusions: Optimal serum ferritin for OIT is 67.4–89.9 pmol/L in HD patients with IDA/minor inflammation. IIT may be a second line of treatment for OIT-nonreponders. View Full-Text
Keywords: ferritin; hemodialysis; hepcidin-25; inflammation; iron deficiency anemia; oral iron therapy ferritin; hemodialysis; hepcidin-25; inflammation; iron deficiency anemia; oral iron therapy
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Takasawa, K.; Takaeda, C.; Wada, T.; Ueda, N. Optimal Serum Ferritin Levels for Iron Deficiency Anemia during Oral Iron Therapy (OIT) in Japanese Hemodialysis Patients with Minor Inflammation and Benefit of Intravenous Iron Therapy for OIT-Nonresponders. Nutrients 2018, 10, 428.

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