Efficiency of ferric carboxymaltose in non-dialysis CKD patients and its impact on kidney function: a prospective observational study.

BACKGROUND: Iron deficiency anemia occurs in most patients with non-dialysis chronic kidney disease (ND-CKD). Previous studies have suggested that intravenous (IV) iron therapy is more effective than oral iron in these patients. Clinical evidence relating the effects of IV iron on renal function is, however, limited. METHODS: Prospective observational study of adult patients with ND-CKD, anemia, iron deficiency, and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, treated with a single dose of 500 mg or 1000 mg of ferric carboxymaltose (FCM) and followed-up for 24 weeks. Primary outcome was FCM efficacy, assessed by comparing Hb, TSAT and ferritin at 24 weeks with those at baseline. Secondary outcome was FCM impact on renal function, evaluated by comparing eGFR over the same period. RESULTS: One hundred and forty patients were recruited: seventy-eight (55.7%) were treated with 1000 mg and 62 (44.3%) with 500 mg of FCM. 24 weeks after FCM administration, Hb increased 1.54 ± 1.99 g/dL (95% CI 1.09-1.99, p = 001) in the group treated with 1000 mg and 0.86 ± 1.4 g/dL (95% CI 0.53-1.22, p = 0.001) in those treated with 500 mg. TSAT increased in both groups but more in those treated with 1000 mg, and ferritin only increased in the latter. Estimated GFR showed a significant increase of 1.55 ± 6.86 mL/min/m2 (95% CI 0.05-3.09, p = 0.049), from a baseline of 27.73 ± 17.23 to 28.88 ± 18.02 mL/min/m2 in the group treated with 1000 mg. CONCLUSIONS: Our findings suggested that IV FCM therapy was effective in improving serum iron levels and anemia in ND-CKD stage 3 to 5 patients. Higher doses seem to be necessary to replace depleted iron stores. In our cohort, IV FCM therapy was associated with an improvement in renal function, particularly in those treated with higher doses of FCM.

Bariatric surgery and hemodialysis: A case report of a patient with less 40 kilograms and without dialysis.

Obesity is an important risk factor for chronic kidney disease. Bariatric surgery (BS) may improve long-term kidney outcomes, but there is no agreement regarding the benefit and timing of BS in patients with end-stage renal disease. We present a 46-year-old male patient with type 2 diabetes mellitus, in hemodialysis (HD), and with a body mass index (BMI) of 39.79 kg/m2, who was submitted to laparoscopic one-anastomosis gastric bypass surgery. Eight months after surgery, and after a 40-kg weight loss, the patient showed signs of kidney function improvement and HD was discontinued. At this moment, one year after, the patient has an estimated glomerular filtration rate of 21.2 mL/min/1.73 m2 and a BMI of 25.61 kg/m2. To our knowledge, this case report seems to be the first one to talk about a HD patient that improved kidney function enough to stop dialysis.