A parallel group, quadruple blind, placebo-controlled, randomized control trial with 2x2 factorial design to determine the effect of simultaneous IV ferric carboxymaltose and IM hydroxycobalamin supplementation in anemic Indian HD patients
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
100
Single dose of ferric carboxymaltose (Encicarb, Emcure Pharmaceuticals Ltd., Pune, India) 500 mg administered intravenously in 100 ml normal saline over 1 hour via the dialysis blood line immediately following HD
Single dose of hydroxycobalamine (Trineurosol Hp, Tridoss Laboratories, Mumbai, India) 1000 mcg administered intramuscularly in the deltoid of the non-fistula arm immediately following HD
Single dose of 1 ml of distilled water injected intramuscularly in the deltoid of the non-fistula arm immediately following HD
Christian Medical College, Vellore
Vellore, Tamil Nadu, India
RECRUITINGMean haemoglobin
Mean haemoglobin measured 30 days after the intervention
Time frame: 30 days
Sensitivity and specificity of baseline automated red cell indices, peripheral smear red cell indices, and iron indices for diagnosis of iron deficiency
Sensitivity and specificity of baseline peripheral smear hypochromic RBCs \>10%, peripheral smear red blood cell anisocytosis \> 10%, percentage hypochromic mature red cells (%HYPOm) \>6%, reticulocyte hemoglobin content (CHr) \< 30 pg, transferrin saturation (TSAT), and serum ferritin, for the diagnosis of iron deficiency anemia. Iron deficiency anemia is defined by an increase in corrected reticulocyte index (reticulocyte % x hematocrit/40) \>1% at 7 days and/or increase in hemoglobin by ≥1 g/dL 30 days after administration of IV FCM in the FCM +placebo arm.
Time frame: Baseline
Optimum cutoff for baseline automated red cell indices for the diagnosis of iron deficiency anemia using ROC curve analysis
Optimum cutoff of baseline %HYPOm and CHr for the diagnosis of iron deficiency anemia using ROC curve analysis. Iron deficiency anemia is defined by an increase in corrected reticulocyte index (reticulocyte % x hematocrit/40) \>1% at 7 days and/or increase in hemoglobin by ≥1 g/dL 30 days after administration of IV FCM in the FCM +placebo arm.
Time frame: Baseline
Sensitivity and specificity of baseline peripheral blood smear hypochromia, peripheral blood smear anisocytosis and automated red cell indices for the diagnosis of iron deficiency anemia in participants with TSAT < 30% and TSAT > =30%.
Sensitivity and specificity of \> 10% hypochromic red blood cells on peripheral blood smear, \>10% red blood cell anisocytosis on peripheral blood smear, %HYPOm \> 6%, and CHr \< 30 pg measured at baseline, for the diagnosis of iron deficiency anemia in participants with baseline TSAT \< 30% and TSAT \> 30% respectively. Iron deficiency anemia is defined by an increase in corrected reticulocyte index (reticulocyte % x hematocrit/40) \>1% at 7 days and/or increase in hemoglobin by ≥1 g/dL 30 days after administration of IV FCM in the FCM +placebo arm.
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Single dose of 100 ml normal saline administered intravenously over 1 hour via the dialysis blood line immediately following HD
Time frame: Baseline
Sensitivity and specificity of baseline peripheral smear neutrophil hypersegmentation and cell population data for the diagnosis of B12 deficiency.
Sensitivity and specificity of baseline peripheral smear neutrophil hypersegmentation (\>3 percent of neutrophils with ≥5 lobes or ≥1 neutrophil with ≥6 lobes per 100 neutrophils) and cell population data \[mean neutrophil volume \> 145 fl or mean monocyte volume \> 168 fl\] for the diagnosis of B12 deficiency. B12 deficiency is defined as an increase in corrected reticulocyte index \> 1% (reticulocyte % x hematocrit/40) at 7 days and/or increase in hemoglobin by ≥1 g/dL 30 days after administration of IM hydroxycobalamin in the B12 + placebo group.
Time frame: Baseline
Optimum cutoff of cell population data for the diagnosis of B12 deficiency using ROC curve analysis
Optimum cutoff of baseline mean neutrophil volume and mean monocyte volume for the diagnosis of B12 deficiency using ROC curve analysis. B12 deficiency is defined as an increase in corrected reticulocyte index \> 1% (reticulocyte % x hematocrit/40) at 7 days and/or increase in hemoglobin by ≥1 g/dL 30 days after administration of IM hydroxycobalamin in the B12 + placebo group.
Time frame: Baseline
Adverse effects of IV ferric carboxymaltose and IM hydroxycobalamin therapy
Any adverse events attributable to the use of IV ferric carboxymaltoise and/or IM hydroxycobalamin
Time frame: Day 0