Anemia and Iron Deficiency in COPD: ESAs and IV Iron
Approval of the study was granted by the Ethical Committee of the Tel-Aviv Medical Center.
We examined the hospital records of all patients admitted with an AECOPD between January 1, 2012 to December 31 2012 to assess the prevalence, the investigation and treatment of anemia and ID in these patients. COPD diagnosis was based on information encoded in the administrative database.
We identified 12 anemic (defined as Hb < 12 g/dl) patients with an established diagnosis of COPD who had been treated in our clinic. We analyzed the effects of the combination of subcutaneous ESAs and IV-iron on dyspnea in these patients. Patient characteristics that were examined at baseline included presence of CKD, CHF, hypertension, diabetes, dyslipidemia and the medications taken.
The anemia was corrected with the combination of ESAs and IV-iron given once weekly for 5 weeks and the final assessment was done one week after the last dose. IV iron (200 mg of elemental iron) was given as two 5 ml ampoules- each containing a total of 100 mg of elemental iron) of Venofer -Ferric Sucrose (Vifor Int, St. Galen, Switzerland). The doses were given one week apart (a total of 1000 mg elemental iron) for 5 weeks. ESAs were given weekly in the form of 10,000 International Units (IU) of subcutaneous (sc) Recormon (Roche, Basel, Switzerland) for five weeks at the same time that the IV iron was given. Weight, height, and blood pressure were measured on every weekly visit. Blood work, done initially, at every visit and one week after the fifth treatment, included: Hemoglobin (Hb), Hematocrit (Hct), Red Blood Cells (RBCs) and RBC indices, Red Cell Distribution Width (RDW), platelets, serum iron, Transferrin, percent transferrin saturation (%Tsat) defined as serum iron divided by serum transferrin multiplied by 100%, serum ferritin, albumin, SGOT, SGPT, serum creatinine. Several definitions for ID were suggested and here we defined ID by three different criteria: (i) serum ferritin of <100 ng/ml, (ii) %TSat <20%, or (iii) either a serum ferritin of <100 ng/ml or the combination of serum ferritin of 100–300 ng/ml and %TSat of <20%. Estimated glomerular filtration rate (eGFR) was calculated by the MDRD equation.
Pulmonary function was performed by spirometry which was performed in accordance with the recommendations of the American Thoracic Society. The one second Forced Expiratory Volume (FEV1), Forced Vital Capacity (FVC) and the FEV1/FVC, all assessed as percent of predicted values, were measured before but not after the EPO-IV iron therapy.
Health perception was assessed at baseline and one week after the fifth injection of EPO and IV iron. We used a Visual Analog Scale (VAS) making a line 10 cm in length, in which a score of 0 at one end corresponds to extremely severe dyspnea on walking a short distance or at rest and a score of 10 at the other end corresponds to no dyspnea on walking or at rest. The patient placed an X on what they considered their current status before and 1 week after the last dose of the combination treatment.
All results of Study 2 are reported as median and interquartile range [IQR]. All variables did not follow a normal distribution and were therefore analyzed by the Wilcoxon signed rank sum test to evaluate the changes in them after treatment. The Spearman correlation coefficients were calculated between pre- and post values of all parameters to examine the relationships between the two measurements. A two-tailed value of p < 0.05 was considered to be significant.
Statistical analysis was performed by SAS for windows version 9.2.
Methods
Approval of the study was granted by the Ethical Committee of the Tel-Aviv Medical Center.
Study 1
We examined the hospital records of all patients admitted with an AECOPD between January 1, 2012 to December 31 2012 to assess the prevalence, the investigation and treatment of anemia and ID in these patients. COPD diagnosis was based on information encoded in the administrative database.
Study 2
We identified 12 anemic (defined as Hb < 12 g/dl) patients with an established diagnosis of COPD who had been treated in our clinic. We analyzed the effects of the combination of subcutaneous ESAs and IV-iron on dyspnea in these patients. Patient characteristics that were examined at baseline included presence of CKD, CHF, hypertension, diabetes, dyslipidemia and the medications taken.
The anemia was corrected with the combination of ESAs and IV-iron given once weekly for 5 weeks and the final assessment was done one week after the last dose. IV iron (200 mg of elemental iron) was given as two 5 ml ampoules- each containing a total of 100 mg of elemental iron) of Venofer -Ferric Sucrose (Vifor Int, St. Galen, Switzerland). The doses were given one week apart (a total of 1000 mg elemental iron) for 5 weeks. ESAs were given weekly in the form of 10,000 International Units (IU) of subcutaneous (sc) Recormon (Roche, Basel, Switzerland) for five weeks at the same time that the IV iron was given. Weight, height, and blood pressure were measured on every weekly visit. Blood work, done initially, at every visit and one week after the fifth treatment, included: Hemoglobin (Hb), Hematocrit (Hct), Red Blood Cells (RBCs) and RBC indices, Red Cell Distribution Width (RDW), platelets, serum iron, Transferrin, percent transferrin saturation (%Tsat) defined as serum iron divided by serum transferrin multiplied by 100%, serum ferritin, albumin, SGOT, SGPT, serum creatinine. Several definitions for ID were suggested and here we defined ID by three different criteria: (i) serum ferritin of <100 ng/ml, (ii) %TSat <20%, or (iii) either a serum ferritin of <100 ng/ml or the combination of serum ferritin of 100–300 ng/ml and %TSat of <20%. Estimated glomerular filtration rate (eGFR) was calculated by the MDRD equation.
Pulmonary function was performed by spirometry which was performed in accordance with the recommendations of the American Thoracic Society. The one second Forced Expiratory Volume (FEV1), Forced Vital Capacity (FVC) and the FEV1/FVC, all assessed as percent of predicted values, were measured before but not after the EPO-IV iron therapy.
Health perception was assessed at baseline and one week after the fifth injection of EPO and IV iron. We used a Visual Analog Scale (VAS) making a line 10 cm in length, in which a score of 0 at one end corresponds to extremely severe dyspnea on walking a short distance or at rest and a score of 10 at the other end corresponds to no dyspnea on walking or at rest. The patient placed an X on what they considered their current status before and 1 week after the last dose of the combination treatment.
Statistical Analysis
All results of Study 2 are reported as median and interquartile range [IQR]. All variables did not follow a normal distribution and were therefore analyzed by the Wilcoxon signed rank sum test to evaluate the changes in them after treatment. The Spearman correlation coefficients were calculated between pre- and post values of all parameters to examine the relationships between the two measurements. A two-tailed value of p < 0.05 was considered to be significant.
Statistical analysis was performed by SAS for windows version 9.2.
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