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Open Access Highly Accessed Research article

Iron repletion is associated with reduction in platelet counts in non-dialysis chronic kidney disease patients independent of erythropoiesis-stimulating agent use: a retrospective cohort study

Lenar Yessayan1*, Jerry Yee1, Gary Zasuwa1, Stan Frinak1 and Anatole Besarab2

Author Affiliations

1 Division of Nephrology and Hypertension, Henry Ford Hospital, 2799 W. Grand Blvd, CFP-514, Detroit, MI, USA

2 Division of Nephrology and Hypertension, University of California, San Francisco, CA, USA

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BMC Nephrology 2014, 15:119  doi:10.1186/1471-2369-15-119

Published: 19 July 2014

Abstract

Background

Iron deficiency is common in non-dialysis chronic kidney disease (ND-CKD) patients and, on occasion, requires parenteral iron therapy. We investigated the effect of intravenous iron repletion on platelet counts in ND-CKD patients with and without concomitant darbepoetin administration.

Methods

We conducted a retrospective analysis of ND-CKD patients with iron deficiency anemia treated with low molecular weight iron dextran (LMWID) between 2005 and 2009 at our CKD clinic. The primary end-point was change in platelet count 60 days post infusion of LMWID in those with and without concomitant darbepoetin administration. Secondary end-points were the correlations between changes in platelet count and iron indices.

Results

A total of 108 patients met inclusion and exclusion criteria. The decrease in platelet counts in response to iron repletion was statistically significant (305.72 ± 108.86 vs 255.58 ± 78.97, P = < .0001). The decrease in platelet count was independent of concomitant darbepoetin use. Bivariate regression analysis between baseline platelet count and transferrin saturation by iron (TSAT) showed a negative association (βTSAT = −5.82, P = .0007) and moderate correlation (R = 0.32). Following iron treatment, the within individual changes in platelet count in 60 days were not related to changes in TSAT (βΔTSAT = −0.41, P = .399) and demonstrated a poor correlation (R = 0.10).

Conclusions

Parenteral iron treatment by LMWID is associated with reduction in platelet counts in iron deficient anemic ND-CKD patients. However, ESA use in the majority of patients prior to intravenous iron administration could have altered platelet production through bone marrow competition.

Keywords:
Thrombocytosis; Platelet count; Iron deficiency anemia; Erythropoietin; Intravenous iron dextran