ERYTHROPOIETIN WITH AND WITHOUT IRON: A PROSPECTIVE STUDY ON HEMATOLOGICAL OUTCOMES, QUALITY OF LIFE, AND ECONOMIC BURDEN IN DIALYSIS PATIENTS

Anushka Kalash*, Shubranshu Panda, Pooja Brahambhatt, Asmita Roy, Aman Saini, Navneet Saxena

ABSTRACT

Background: Anemia is a common complication in chronic kidney disease (CKD) patients undergoing
hemodialysis due to reduced erythropoietin production and impaired iron utilization. Methods: This prospective
observational study included 51 patients, of whom 50 completed 6-month follow- up. Patients received either
erythropoietin (EPO) alone or EPO with intravenous (IV) iron. Outcomes included haematological parameters,
quality of life (QoL) and economic burden. Results: Combination therapy was associated with higher haemoglobin
levels at 6 month (11.23 ± 1.34 vs 10.45 ± 1.21 g/dl; mean difference: 0.78, 95 %CL: 0.05- 1.51; p= 0.042).
Serum ferritin, serum iron, and transferrin saturation were also higher in the combination group (p < 0.05). Mean
haemoglobin increase from baseline was greater in the combination group (+ 3.66 vs +3.07 g/dl). Quality of life
scores improved across all domain, though the magnitude was modest. Total treatment cost was higher in the
combination group (Rs 7,460 ±910 vs Rs 6,230 ± 850; mean difference: Rs 1,230, 95%CL: Rs 210 – RS 2,250; p =
0.029), no major safety concerns were observed. Conclusion: Combination therapy was associated with improved
hematological outcomes but higher cost and modest QoL benefits, suggesting the need for individualized treatment
strategies.

Keywords: Iron therapy, Erythropoietin, Chronic Kidney Disease, Haemodialysis, Anaemia.