Prescript peritoneal dialysis: Patterns of iron prescribing in peritoneal dialysis

Abstract

Background

Iron deficiency and anaemia are prevalent in people undergoing peritoneal dialysis (PD), necessitating effective iron supplementation. While oral iron is often preferred for its accessibility and cost, it may be insufficient or poorly tolerated. Intravenous (IV) iron is generally well tolerated and associated with improved haemoglobin response and reduced erythropoiesis-stimulating agent requirements, yet optimal dosing, administration intervals, and haematological targets remain under-researched, particularly in PD populations. Current prescribing practices vary significantly, reflecting gaps in evidence and consensus. This study aimed to evaluate UK clinical practices for iron therapy in PD and estimate patient eligibility for a future randomised controlled trial (RCT).

Methods

A cross-sectional survey was conducted among UK-based kidney clinicians using a structured 9-item questionnaire distributed electronically via the UK Kidney Association. The survey explored iron repletion strategies, diagnostic thresholds, and circumstances for withholding therapy. Responses were analysed using descriptive statistics for quantitative data and thematic analysis for free-text responses.

Results

A total of 41 clinicians from 23 dialysis units participated, including consultants (73.2%), registrars (17.1%), and specialist nurses (9.7%). High-dose IV iron (≥500 mg per visit) was the preferred strategy for 65.9% of respondents, while none used oral iron alone. Most clinicians initiated iron therapy when serum ferritin was <200 µg/L (53.7%) or transferrin saturation (TSAT) was <20% (78.1%). Diagnostic measures beyond serum ferritin and TSAT, such as reticulocyte haemoglobin content, were rarely used (14.6%). The majority avoided iron therapy in the presence of active infection (90.2%) or IV iron allergy (92.7%). Estimates of trial eligibility indicated that 6–10% of people receiving PD might not meet inclusion criteria, largely due to elevated C-reactive protein, ferritin, or TSAT levels.

Conclusions

This survey highlights significant variability in iron therapy practices for people receiving PD in the UK. Most clinicians favour high-dose IV iron, reflecting its practical advantages in outpatient settings. However, diagnostic and safety concerns remain, with limited use of advanced biomarkers and inconsistent thresholds for therapy initiation. These findings underscore the need for a robust RCT to address gaps in evidence, establish optimal iron repletion strategies, and ensure safe and effective anaemia management in PD populations.