What do we learn about the “Anemia Module” of the French language Peritoneal Dialysis ? Interest and Results
Keywords:anémie, dialyse péritonéale, hémodialyse, ferritine, fer intraveineux, RDPLF
Background: Anemia is commonly observed in patients with chronic kidney disease (CKD) as soon as the glomerular filtration rate falls below than 30 ml/min. CKD patients frequently have iron deficiency. The use of both erythropoiesis-stimulating agents (ESA) and iron therapy is the backbone of anemia management in CKD. For this reason, an adequate iron supply is mandatory to achieve the optimal therapeutic benefit of erythropoiesis stimulating agents (ESAs). Many groups agree that anemia in peritoneal dialysis (PD) patients is less severe than in hemodialysis (HD) patients and that there are important differences in treatment practices for anemia between PD and HD patients.
Methods: Analysis of the Anemia module of the French Language Peritoneal Dialysis Registry (RDPLF) register from the database set up in 2005 with a study of the period 2010-2017.
Results: Data from 568 patients who participated in the Anemia module were analysed during the 2010-2017 follow-up period. Their median age were 71 years, 42% were female, median dialysis vintage was 13 months, 40,5% of patients had diabetes mellitus, 74% of patients were treated with ESA, 23% were on oral iron and only 11% have received intravenous iron. In terms of biological assessment, the average hemoglobin level was close to 12 g/dl and median CRP was close to 5 mg/l. For the iron balance, ferritin reached an average level of 270 µg/l in 2013 and stabilized in 2017 at 200 µg/l. The transferrin saturation coefficient always fluctuated between 23 % and 25 % from year 2010 to year 2017.
Conclusion: The results of the Anemia module of RDPLF register appear to be in line with the target values of the ERA-EDTA latest European guideline on anemia (ERBP 2013) and show the low use of intravenous iron in PD (usually as second line therapy).
Hörl Wh. Clinical aspects of iron use in the anemia of kidney disease. J.Am Soc Nephrol 2007; 18(2)/ 382-393
Jacob C, Dieter F,and Perkins Alan C. Results of the European Survey on Anemia Management 2003 (ESMA 2003). Current status of anemia management in dialysis patients, factors affecting epoïetin dosage and changes in anemia over the last 5 years. Nephrol Dial Transplant (2005) 20 (suppl 3) iii 23 iii24
Rostoker G, Vasiri ND, Fishbane S. Iatrogenic iron overload in dialysis patients at the beginning of the 21St century. Drugs. 2016 M%ay, 76 (7): 741-57.
Barton JC, Edwards CQ, Phatak PD et al. Handbook of iron overload disorders. Cambridge University press, 2010.
Traitement de l’anémie des hémodialysés par solutions de fer IV: L’ANSM rappelle la nécessité de respecter les schémas posologiques de l’AMM-point d’information 18/02/2013
The DOPPS practice Monitor. Slide Browser. Available from: http://www.dopps.org/dpm/. Accessed june 18, 2018
Gandon y, Olivié D, Guyader D et al ; Non- invasive assessment of hepatic iron stores by MRI. Lancet 32004, 357-362
Richardson D, Bartlett C, Jolly H et al. Intravenous iron for CAPD populations: proactive or reactive strategies? Nephrol Dial Transplant. 2001 , 16; 115-119
Vychytil A, Haag- Weber M. Iron status and iron supplementation in peritoneal dial:ysis patients. Kidney Int. 1999; 55 (suppl 69) S71-9)
Rottembourg J, Rostoker G. Use of intravenous iron supplementation in chronic kidney disease: Interests, limits and recommendations for a better practice. Nephrol Therap 2015; 11 (7): 531-542
Macdougall IC, Bircher AJ, Eckardt KU et al. Conference participants. Iron management in chronic kidney disease: conclusion from a “kidney Disease”: improving Global outcomes (KDIGO) controversies conference. Kidney Int 2016; 89(1): 28-39
Locatelli F, Barany P, Covic A et al on behalf of the ERA-EDTA ERBP advisory board. Kidney disease: improving global outcomes guidelines on anemia management in chronic kidney disease: an European Renal Best position statement . Nephrol Dial Transplant. 2013; 28(6): 1346-1359
Ghoti H, Rachmilewtz EA, Simon –Lopez R et al. Evidence for tissue iron overload in long- term hemodialysis patients and the impact of withdrawing parenteral iron. Eur J Heamatol 2012; 89 (1): 87-93
Cavanese C, Bergamo D, Ciccone G et al. Validation of serum values by magnetic susceptometry in predicting iron overload in dialysis patients. Kidney Int 2004; 65 (3): 1091-1098
Rostoker G,Gruncelli MLT, Loridon Ch et al. Hemodialysis –associated hemosiderosis in the Era of Erythropoiesis-stimulating Agents: A MRI Study. The Am journal of Medecine (2012) 125, 991-999.
Issad B, Ghali N, Beaudreuil S et al. Hepatic iron load at magnetic resonance imaging is normal in most patients receiving peritoneal dialysis. Kidney Int Reports 2017; 2: 1219-122
How to Cite
Copyright (c) 2019 Issad Belkacem
This work is licensed under a Creative Commons Attribution 4.0 International License.