Abstract
The administration of ferric citrate hydrate (FCH), an iron-based phosphate binder, increases patients’ hemoglobin (Hb) levels via iron absorption. However, some patients’ Hb levels can overshoot the target level despite reductions in the use of erythropoiesis stimulating agents (ESA). We retrospectively reviewed the cases of patients that were undergoing hemodialysis and were treated with FCH and determined which patients exhibited Hb overshoot. We defined Hb overshoot as a maximum Hb level of ≥14.0 g/dL or an increase in the Hb level of ≥3.0 g/dL from the baseline. Among the 20 examined patients, 11 displayed Hb overshoot (overshoot group, OS), and 9 patients did not (non-OS group). There were no significant differences between the clinical characteristics of the two groups prior to the administration of FCH. In the OS group, the Hb levels recorded after 2 and 3 months were significantly higher than those seen in the non-OS group. In the OS group, the red cell distribution width-coefficient of variation (RDW-CV) and the mean corpuscular volume (MCV) were higher in the OS group than in the non-OS group after 1 (p=0.0240 and 0.0411, respectively) and 2 months (p=0.0190 and 0.0411, respectively). The reduction in the use of ESA did not differ significantly between the two groups. As RDW-CV and MCV rose significantly before the Hb level increased in the OS group, higher RDW-CV and MCV values might be useful predictors of Hb overshoot in patients undergoing hemodialysis who receive FCH.
