Key result
Preoperative IV iron is linked to a ~7 g/L hemoglobin increase and improved peak oxygen consumption.
Why the study?
Anemia is associated with impaired physical performance and adverse perioperative outcomes, but the relationship between exercise capacity, anemia, total hemoglobin mass, and the response to preoperative intravenous iron was unexplored.
Does intravenous ferric derisomaltose improve exercise capacity and hemoglobin mass in preoperative patients with iron-deficiency anemia?
Observational (n=26)
Open-label
No
Does intravenous ferric derisomaltose improve exercise capacity and hemoglobin mass in preoperative patients with iron-deficiency anemia?
Mean Difference: 7.3 (95% CI 4.5–10.1)
Absolute Event Rate: 116% vs 109%
p-value: p=<0.0001
Preoperative intravenous iron administration in iron-deficient anemic patients significantly improves hemoglobin mass and peak exercise capacity.
Background Anemia is associated with impaired physical performance and adverse perioperative outcomes. Iron-deficiency anemia is increasingly treated with intravenous iron before elective surgery. We explored the relationship between exercise capacity, anemia, and total hemoglobin mass (tHb-mass) and the response to intravenous iron in anemic patients prior to surgery. Methods A prospective clinical study was undertaken in patients having routine cardiopulmonary exercise testing (CPET) with a hemoglobin concentration ([Hb]) < 130 g.l−1 and iron deficiency/depletion. Patients underwent CPET and tHb-mass measurements before and a minimum of 14 days after receiving intravenous (i.v.) Ferric derisomaltose (Monofer®) at the baseline visit. Comparative analysis of hematological and CPET variables was performed pre and post-iron treatment. Results Twenty-six subjects were recruited, of whom 6 withdrew prior to study completion. The remaining 20 (9 [45%] male; mean ± SD age 68 ± 10 years) were assessed 25 ± 7 days between baseline and the final visit. Following i.v. iron, increases were seen in [Hb] (mean ± SD) from 109 ± 14 to 116 ± 12 g l−1 (mean rise 6.4% or 7.3 g l−1, p = < 0.0001, 95% CI 4.5–10.1); tHb-mass from 497 ± 134 to 546 ± 139 g (mean rise 9.3% or 49 g, p = < 0.0001, 95% CI 29.4–69.2). Oxygen consumption at anerobic threshold ( V̇ V ˙ O2 AT) did not change (9.1 ± 1.7 to 9.8 ± 2.5 ml kg−1 min−1, p = 0.09, 95% CI − 0.13 − 1.3). Peak oxygen consumption ( V̇ V ˙ O2 peak) increased from 15.2 ± 4.1 to 16 ± 4.4 ml.kg.−1 min−1, p = 0.02, 95% CI 0.2–1.8) and peak work rate increased from 93 [67–112] watts to 96 [68–122] watts (p = 0.02, 95% CI 1.3–10.8). Conclusion Preoperative administration of intravenous iron to iron-deficient/deplete anemic patients is associated with increases in [Hb], tHb-mass, peak oxygen consumption, and peak work rate. Further appropriately powered prospective studies are required to ascertain whether improvements in tHb-mass and performance in turn lead to reductions in perioperative morbidity. Trial registration ClinicalTrials.gov identifier: NCT 033 46213.
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Plumb et al. (2023) conducted an observational in Preoperative iron-deficiency anemia (n=26). Intravenous Ferric derisomaltose vs. Baseline (pre-treatment) was evaluated on Change in hemoglobin concentration ([Hb]) (MD 7.3, 95% CI 4.5-10.1, p=<0.0001). Preoperative administration of intravenous iron to iron-deficient anemic patients significantly increased hemoglobin concentration by a mean of 7.3 g/L, total hemoglobin mass, and peak oxygen consumption.
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