Comparing Reticulocyte Hemoglobin and Transferrin Saturation to Guide Iron Treatment in People on Dialysis

NCT ID: NCT06906835

Last Updated: 2025-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-31

Study Completion Date

2025-09-30

Brief Summary

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The goal of this clinical trial is to find out which method is better for guiding iron treatment in adult patients with end-stage kidney disease (ESKD) on hemodialysis who have anemia.

The main questions it aims to answer are:

Can using reticulocyte hemoglobin equivalent (RET-He) to guide intravenous (IV) iron treatment be as effective as using transferrin saturation (TSAT)?

Does the method used to guide iron treatment affect outcomes such as death, heart problems, hospitalizations, infections, or the need for blood transfusions?

Researchers will compare RET-He-guided iron treatment with TSAT-guided iron treatment to see if RET-He works just as well and has similar or better outcomes.

Participants will:

Receive IV iron based on either RET-He or TSAT levels

Have blood tests done at the start, 3 months, and 6 months

Have their doses of iron and erythropoietin (a medication to treat anemia) adjusted based on the assigned protocol

Be monitored for clinical outcomes such as hospitalization, heart events, and infections

Detailed Description

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Conditions

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Hemodialysis Anemia in End Stage Renal Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Cluster randomization
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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RET-He-Guided Iron Supplementation

Participants in this arm will receive intravenous (IV) iron therapy guided by reticulocyte hemoglobin equivalent (RET-He) levels.

Group Type EXPERIMENTAL

RET-He-Guided Iron Supplementation

Intervention Type OTHER

Participants in this arm will receive intravenous (IV) iron therapy guided by reticulocyte hemoglobin equivalent (RET-He) levels.

Iron dosing will follow a protocol based on RET-He values:

* RET-He \< 26 pg: IV iron 100 mg weekly
* RET-He ≥ 26 pg and \< 30 pg: IV iron 100 mg every 2 weeks
* RET-He ≥ 30 pg and ≤ 36 pg: IV iron 100 mg every 4 weeks
* RET-He \> 36 pg or ferritin ≥ 800 ng/mL: Discontinue iron supplementation to prevent iron overload

Common

Intervention Type OTHER

All participants will receive erythropoiesis-stimulating agents (ESAs) according to a standardized dose adjustment protocol based on hemoglobin levels.

Oral iron supplements will be discontinued.

TSAT-Guided Iron Supplementation

Participants in this arm will receive IV iron therapy guided by transferrin saturation (TSAT) and serum ferritin.

Group Type ACTIVE_COMPARATOR

TSAT-Guided Iron Supplementation

Intervention Type OTHER

Participants in this arm will receive IV iron therapy guided by transferrin saturation (TSAT) and serum ferritin, as per the Thai Clinical Practice Guidelines for Anemia in CKD (2021).

Iron dosing will follow this TSAT-based protocol:

* TSAT \< 30% and ferritin \< 200 ng/mL: IV iron 100 mg weekly
* TSAT \< 30% and ferritin 200-500 ng/mL: IV iron 100 mg every 2 weeks
* TSAT \< 30% and ferritin 500-800 ng/mL or TSAT 30-40%: IV iron 100 mg every 4 weeks
* TSAT ≥ 40% or ferritin ≥ 800 ng/mL: Discontinue iron supplementation

Common

Intervention Type OTHER

All participants will receive erythropoiesis-stimulating agents (ESAs) according to a standardized dose adjustment protocol based on hemoglobin levels.

Oral iron supplements will be discontinued.

Interventions

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RET-He-Guided Iron Supplementation

Participants in this arm will receive intravenous (IV) iron therapy guided by reticulocyte hemoglobin equivalent (RET-He) levels.

Iron dosing will follow a protocol based on RET-He values:

* RET-He \< 26 pg: IV iron 100 mg weekly
* RET-He ≥ 26 pg and \< 30 pg: IV iron 100 mg every 2 weeks
* RET-He ≥ 30 pg and ≤ 36 pg: IV iron 100 mg every 4 weeks
* RET-He \> 36 pg or ferritin ≥ 800 ng/mL: Discontinue iron supplementation to prevent iron overload

Intervention Type OTHER

TSAT-Guided Iron Supplementation

Participants in this arm will receive IV iron therapy guided by transferrin saturation (TSAT) and serum ferritin, as per the Thai Clinical Practice Guidelines for Anemia in CKD (2021).

Iron dosing will follow this TSAT-based protocol:

* TSAT \< 30% and ferritin \< 200 ng/mL: IV iron 100 mg weekly
* TSAT \< 30% and ferritin 200-500 ng/mL: IV iron 100 mg every 2 weeks
* TSAT \< 30% and ferritin 500-800 ng/mL or TSAT 30-40%: IV iron 100 mg every 4 weeks
* TSAT ≥ 40% or ferritin ≥ 800 ng/mL: Discontinue iron supplementation

Intervention Type OTHER

Common

All participants will receive erythropoiesis-stimulating agents (ESAs) according to a standardized dose adjustment protocol based on hemoglobin levels.

Oral iron supplements will be discontinued.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult (age 18-80 years)
* ESKD on chronic hemodialysis ≥ 6 months
* EPO therapy ≥ 6 months
* Hb \< 13.0 g/dL in male, \< 12.0 g/dL in female

Exclusion Criteria

* Serum ferritin \> 800 ng/mL or TSAT \> 40%
* Active infection or malignancy
* Hematologic disease including thalassemia major, hemolysis, myelofibrosis or myelodysplastic disease
* History of marrow suppressive or immunosuppressive medications in past 6 months
* History of active heart failure and recent myocardial infarction /stroke in past 6 months
* History of GI or external bleeding or receiving blood transfusion in past 6 months
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sysmex Asia Pacific

INDUSTRY

Sponsor Role collaborator

Center of Excellence for Metabolic Bone Disease in CKD patients, Faculty of Medicine, Chulalongkorn University

UNKNOWN

Sponsor Role collaborator

King Chulalongkorn Memorial Hospital

OTHER

Sponsor Role lead

Responsible Party

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Jeerath Phannajit

Chief, Division of Clinical Epidemiology, Department of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Paweena Susantitaphong M.D, Ph.D.

Role: STUDY_CHAIR

Center of Excellence for Metabolic Bone Disease in CKD patients, Chulalongkorn University

Jeerath Phannajit M.D.

Role: STUDY_DIRECTOR

Division of Clinical Epidemiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross

Chalermchon Suttaluang M.D.

Role: PRINCIPAL_INVESTIGATOR

Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital

Locations

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King Chulalongkorn Memorial Hospital

Pathumwan, Bangkok, Thailand

Site Status RECRUITING

Countries

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Thailand

Central Contacts

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Jeerath Jeerath Phannajit M.D.

Role: CONTACT

+6622564000 ext. 80901

Chalermchon Suttaluang M.D.

Role: CONTACT

Facility Contacts

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Jeerath Phannajit M.D.

Role: primary

6622564000 ext. 80901

References

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Chinudomwong P, Binyasing A, Trongsakul R, Paisooksantivatana K. Diagnostic performance of reticulocyte hemoglobin equivalent in assessing the iron status. J Clin Lab Anal. 2020 Jun;34(6):e23225. doi: 10.1002/jcla.23225. Epub 2020 Feb 11.

Reference Type BACKGROUND
PMID: 32043622 (View on PubMed)

Susantitaphong P, Siribumrungwong M, Takkavatakarn K, Chongthanakorn K, Lieusuwan S, Katavetin P, Tiranathanagul K, Lekhyananda S, Tungsanga K, Vanichakarn S, Eiam-Ong S, Praditpornsilpa K. Effect of Maintenance Intravenous Iron Treatment on Erythropoietin Dose in Chronic Hemodialysis Patients: A Multicenter Randomized Controlled Trial. Can J Kidney Health Dis. 2020 Jun 19;7:2054358120933397. doi: 10.1177/2054358120933397. eCollection 2020.

Reference Type BACKGROUND
PMID: 32612843 (View on PubMed)

Babitt JL, Eisenga MF, Haase VH, Kshirsagar AV, Levin A, Locatelli F, Malyszko J, Swinkels DW, Tarng DC, Cheung M, Jadoul M, Winkelmayer WC, Drueke TB; Conference Participants. Controversies in optimal anemia management: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int. 2021 Jun;99(6):1280-1295. doi: 10.1016/j.kint.2021.03.020. Epub 2021 Apr 8.

Reference Type BACKGROUND
PMID: 33839163 (View on PubMed)

Wish JB, Anker SD, Butler J, Cases A, Stack AG, Macdougall IC. Iron Deficiency in CKD Without Concomitant Anemia. Kidney Int Rep. 2021 Aug 10;6(11):2752-2762. doi: 10.1016/j.ekir.2021.07.032. eCollection 2021 Nov.

Reference Type BACKGROUND
PMID: 34805628 (View on PubMed)

Other Identifiers

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0202/67

Identifier Type: -

Identifier Source: org_study_id

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