Erythropoietin With and Without Iron: A Prospective Study on Hematological Outcomes, Quality of Life, and Economic Burden in Dialysis Patients

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.