EPO and IV iron infusion

[Mentoslfc]

Hello

My mother is CKD stage 5 without dialysis. She is getting EPO injection once in two weeks to treat anaemia. She was given iron infusion shots (500 mg)two months back. She was feeling very energetic just after two weeks. Now her haemoglobin has again came down again. Can anyone please advice me that how frequently doctors can give her IV infusion iron shots along with EPO shots. I am assuming that iron pills are not working for her therefore doctor stopped the iron pill for her. Any advice would be great for me.

[Researcheverything]

I am stage 3b. I take feosol iron tablets once daily with Nordic 250 mg vitamin c gummies 1/2 gummy. My iron saturation has improved since taking the combination. I’m still anemic but not as bad as I used to be. It helps me. I randomly take solgar 100 mcg b12 tablets that help maintain my hemoglobin. Has she had her b12 checked or folate level checked? I’ve had the iron shots but they only last so long and tried the above mentioned combination on my OWN. Some medicines that I’ve taken like prednisone have caused some changes in my iron levels, too I’m not an expert but wanted to share my experience so far.

[Researcheverything in reply to Researcheverything]

I’ve had two infusions as well.

[Mentoslfc in reply to Researcheverything]

Thank you so much for your response 😊.

We will be getting Serum iron, TIBC, transferrin saturation, serum ferritin, and vit B12 test done in a couple of days. Hopefully I will get some more clarity. But thank you so much for sharing your experience.

[Darlenia]

Low iron is a very common issue for those with kidney disease and even more so for those on dialysis. The kidneys make two main hormones, vitamin D and erythropoietin. As kidneys fail, people can experience low iron and calcium levels. EPO injections tries to restore erythropoietin levels so the body can make more iron. It may take a little while for the body to respond. If it takes too long, things can be supplemented by iron tablets or injections. When my hubby was on dialysis, many at his dialysis center received EPO shots (and sometimes an additional iron treatment) on a regular basis. Hope your mom feels better soon. You're a very special person for taking an interest in her care, your mom is fortunate to have you in her life.

[Mentoslfc in reply to Darlenia]

Thank you so much for your words. Now I am getting the clarity that may be she needs iron supplement along with epo shots.I will also try to test her vitamin D levels. Yeah, I can see the falling calcium levels in her report. Thank you once again for your kind words 😊

[Sapphire187]

I have CKD stage 4 and am getting EPO shots every two weeks and IV iron infusions every week for my Anemia. In May/June I had IV iron infusions every week for 5 weeks. This helped some, but within 3 months my Hemoglobin and RBC’s were way down again. In September I started getting the EPO shots (Erythropoietin tells the bone marrow to make more Red Blood Cells) and IV iron infusions again. This has been helping, but I suspect I will have to continue doing this on and off. BTW, Initially I took high potency Iron tablets (65 mg) everyday for just over a year, and it didn’t help, hence the Iron infusions + then the addition of EPO. Hope things go well for your mother.

[Mentoslfc in reply to Sapphire187]

Thank you for your reply. I got my mother checked for iron levels. Serum ferritin was extremely high but iron and transferrin was in normal range. The doctor advised to get the epo injection two times in two weeks and then another one in 15 days after two weeks. Can serum ferritin can be extremely high ? My mothers ferritin was 1100 which is way beyond range…

[Sapphire187]

I am not sure if 1100 is something to be concerned about. I don’t fully understand how all the different components relate together regarding Anemia in people with CKD. The components being (Iron, Ferritin, TIBC, Transferrin Saturation, RBC and Hemoglobin ). Ferritin is a blood protein that stores Iron. My Anemia started in January 2022 and has been ongoing since then. My RBC and Hemoglobin have been low this entire time. My Iron, TIBC have been in the normal range the whole time and my Transferrin Saturation has been Low 50% of the time. My Ferritin has been High the entire time; the highest being 600 ng/dL after my first 5 IV Iron Infusions and lowest being 124 ng/dL. Just before starting this current round of IV Iron Infusions my Ferritin was 300 ng/dL. Not sure what it is today. I don’t understand why I need to get the IV Iron. My problem is I don’t have enough RBC’s and my Hemoglobin is Low. If you find out what is considered too High for Ferritin, I’d be curious to know.

[Mentoslfc]

Thanks again for the response.. and I wish for your good health

The normal range mentioned in the report is 11 to 307 for female. My mother has got IV infusion 4 times in the last 5 months 500 mg each time. I agree completely regarding the complexities of interaction between iron and EPO is difficult to understand. Open source materials just say that if the patient is not responding to EPO shot means one should explore whether there is absolute iron deficiency or functional iron deficiency. Absolute iron deficiency can be handled by IV infusion but functional iron deficiency is difficult. I don’t know which one is effecting my mother. But I have started EPO shots as advised by doctor along with multi vitamin for kidney patients. In few weeks EPO might use the stored iron i.e. ferritin and hopefully it should sort anaemia in few weeks…..

[Sapphire187]

Thanks for your reply and the well wishes. I believe normal range for lab values can vary based on the laboratory doing the testing. In my lab report, the normal range for Ferritin is: 10 - 120 ng/mL. It is always best to do as the doctor advises. Hope it helps with your mother’s anemia. All the best to you and your mom.