Does ferric gluconate lower epoetin requirements in hemodialysis patients with high ferritin levels?

Abstract

The 6-week Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) study demonstrated that the administration of intravenous iron improved anemia in patients on hemodialysis who had high ferritin levels (500–1,200 ng/ml [1,124–2,696 pmol/l]) and were receiving adequate epoetin doses, disproving previous beliefs that intravenous iron does not benefit patients with ferritin levels >500 ng/ml. This commentary discusses the DRIVE-II study, an observational 6-week extension study reported by Kapoian et al. that was designed to measure the impact of prior iron administration on subsequent epoetin dose. The extension study found that the epoetin dose requirement decreased significantly in patients who had received intravenous iron during DRIVE, but did not change in control patients. Although the results are promising, long-term studies with hard end points such as stroke, myocardial infarction, hospitalization for heart failure, and death are needed to confirm the safety of the intravenous iron regimen.