MP416EFFICACY OF ORAL IRON FOR TREATING IRON DEFICIENCY IN ANAEMIC PATIENTS WITH NON-DIALYSIS DEPENDENT CKD (ND-CKD)

Abstract

INTRODUCTION AND AIMS: Oral iron is used widely to treat iron deficiency in patients with ND‐CKD but haematopoietic response rates over time in this setting are poorly documented. METHODS: In the 52‐week FIND‐CKD study, 626 ND‐CKD patients with iron deficiency and anaemia were randomised (2:1:1) to oral iron (ferrous sulphate, 304 mg [100 mg iron]) or to intravenous ferric carboxymaltose (FCM, targeting higher or lower ferritin). Until week 8, additional anaemia therapy was permitted only for rescue. Post hoc, patients were assessed in terms of haematopoietic response, defined as Hb increase ≥1 g/dL from baseline. Early response was defined as response by week 4. Analyses were restricted to patients with Hb data available both at baseline and at the subsequent time point being assessed. RESULTS: By week 52, the cumulative response rate was 83.0% with high‐ferritin FCM compared to 61.7% in the oral iron group and 61.5% with low‐ferritin FCM (excluding patients who started an alternative anaemia management). The time to first response was significantly different between groups, with the most rapid response in the high‐ferritin FCM group (p<0.001) (Figure). The median time to first response was 57, 145 and 169 days with high‐ferritin FCM, oral iron or low‐ferritin FCM, respectively. Among patients who did not respond by week 4 (high‐ferritin FCM 59.1% [88/ 149], oral iron 78.4% [229/292], low‐ferritin 86.1% [124/144]), the median time to first response from baseline was 92, 253 and 187 days, respectively. The time to first response after week 4 in early non‐responders was significantly longer with oral iron or low‐ferritin FCM than with high‐ferritin FCM (p<0.001). Neither the use of comedications known to influence oral iron absorption, or compliance with the prescribed regimen, differed substantially between early responders or non‐responders in the oral iron group. CONCLUSIONS: Approximately 62% of iron‐deficient anaemic patients with NDCKD responded to oral iron, but the median time to response was almost 5 months. Earlier introduction of alternative anaemia management (such as intravenous iron targeting a higher ferritin level, EPO or blood transfusion) in patients with an inadequate early Hb increase after starting oral iron therapy could be considered to avoid ineffective therapy and prolonged anaemia. Figure. Time to response (Hb increase ≥1 g/dL from baseline) (Kaplan‐Meier estimates).