3.2. The Role of Intravenous Iron (Experience of Lithuania)The oral route of iron administration was popular in Lithuania before 1997. Only 7.5% of patients received intravenous iron. After the increased use of intravenous iron in the year 2000 the mean Hb concentration www.selleckchem.com/products/BAY-73-4506.html increased significantly without serious changes in the doses of epoetin (Hb 104 �� 15g/L in 2000 versus 101 �� 16g/L in 1999, P < 0.05, Table 1). However in the period of 2001�C2005 intravenous iron was poorly available in Lithuania. The percentage of patients receiving intravenous iron sharply decreased till 20.9% in 2001, and the Hb concentrations did not change at the expense of significant increase of the epoetin dose in this year (9336 �� 3571U/week versus 7092 �� 3424U/week in 2000, P < 0.001).

Our results coincided with the data of other studies confirming importance of the intravenous route of iron administration in CKD HD patients as compared to oral administration [8, 9]. Intravenous iron administration led to a greater increase in Hb concentration, a lower ESA dose, or both in most studies [4]. Limitations to the prescription of epoetin were introduced by Lithuanian Ministry of Health at the same time with unavailable intravenous iron. This was followed by worsening of the control of renal anemia in 2002. According to this new algorithm target Hb was 100�C105g/L for HD patients and maximum weekly dose of epoetin was 20000IU. The mean Hb concentration decreased to 101 �� 14g/L, the percentage of patients with Hb >100g/L decreased to 51.8%, the percentage of HD patients receiving epoetin decreased to 88.

8%, and the mean weekly dose of epoetin decreased to 7145 �� 3882U, P < 0.001 (Table 1). The rules of renal anemia treatment were very strict in Lithuania, so it was difficult to keep higher Hb concentration. Fortunately usage of intravenous iron (iron dextran and iron sucrose) was restarted in 2005 and situation of anemia control improved. Hb concentration increased to 105 �� 13.8g/L (P < 0.001), the percentage of patients with Hb >100g/L increased to 65.1%, the percentage of HD patients receiving epoetin decreased to 84%, and the mean weekly dose of epoetin decreased from 8121 �� 6243U in 2004 to 6768 �� 4372U in 2005 (Table 2). All these changes were statistically significant. The changes of mean Hb due to influence of national algorithm and deficiency of iron are presented in Figure 1.

Insufficiency of iron increased between 2002 and 2004, and percentage of patients with ferritin <100mcg/L decreased till 18.5% in 2005 (P < 0.001, Table 2). It is true to say that Lithuania had involuntary experiment to show influence of intravenous Carfilzomib iron for the treatment of renal anemia. It is a pity that this experiment was very expensive as it lasted four years and all patients were involved.