Anemia Management among Hemodialysis Patients with High Ferritin Levels

Background: Anemia management strategies among chronic hemodialysis patients with high ferritin levels remains challenging for nephrologists. Objectives: To compare anemia management in stable hemodialysis patients with high (>= 500 ng/ml) vs. low (< 500 ng/ml) ferritin levels Methods: In a single center, record review, cohort study of stable hemodialysis patients who were followed for 24 months, an anemia management policy was amended to discontinue intravenous (IV) iron therapy for stable hemodialysis patients with hemoglobin > 10 g/dl and ferritin >= 500 ng/ml. Erythropoiesis-stimulating-agents (ESA), IV iron doses, and laboratory parameters were compared among patients with high vs. low baseline ferritin levels before and after IV iron cessation. Results: Among 87 patients, 73.6% had baseline ferritin >= 500 ng/ml. Weekly ESA dose was greater among patients with high vs. low ferritin (6788.8 +/- 4727.8 IU/week vs. 3305.0 +/- 2953.9 IU/week, P = 0.001); whereas, cumulative and monthly IV iron doses were significantly lower (1628.2 +/- 1491.1 mg vs. 2557.4 +/- 1398.9 mg, P = 0.011, and 82.9 +/- 85 vs. 140.7 +/- 63.9 mg, P = 0.004). Among patients with high ferritin, IV iron was discontinued for more than 3 months in 41 patients (64%) and completely avoided in 6 (9.5%). ESA dose and hemoglobin levels did not change significantly during this period. Conclusions: Iron cessation in chronic hemodialysis patients with high ferritin levels did not affect hemoglobin level or ESA dose and can be considered as a safe policy for attenuating the risk of chronic iron overload.