METHODS OF REDUCING DOSES OF ERYTHROPOIETIN STIMULATING AGENTS IN HYPORESPONSIVE PATIENTS

1 . A method of treating a dialysis patient that is hyporesponsive to erythropoietin stimulating agent (ESA) comprising:

(a) administering to the patient soluble a ferric pyrophosphate composition (SFP), and

(b) administering to the patient a dose of ESA that is at least 50% less than the dose of ESA required by dialysis patients that are hyporesponsive to ESA and that have not received SFP.

2 . The method of claim 1 wherein the dose of SFP is administered via a parenteral route selected from the group consisting of intramuscular, subcutaneous, intravenous, intradermal, transdermal, transbuccal, sublingual, intra-peritoneal or by dialytic transfer via the hemodialysis solutions or peritoneal dialysis solutions.

3 . The method of claim 1 wherein the dose of SFP is administered orally.

4 . The method of any of the preceding claims wherein the dose of SFP is administered in conjunction with other drugs such as heparin or parenteral nutrition admixtures or dialysis solutions.

5 . The method of any of the preceding claims, wherein the dose of SFP increases or maintains the hemoglobin level of the patient at 9 g/dL or greater.

6 . The method of any one of claims 1 , 2 , 4 and 5 , wherein the dose of SFP is administered via hemodialysate at a dose ranging from 90 μg Fe/L dialysate to 120 μg Fe/L dialysate.

7 . The method of claim 6 , wherein the SFP is administered via hemodialysate at a dose of 110 μg Fe/L dialysate.

8 . The method of any one of claims 1 , 2 , 4 and 5 , wherein the dose of SFP is administered via infusion or intravenous injection at a dose ranging from 2.4 mg to 48 mg iron per day at a rate of 0.1 to 2 mg iron per hour.

9 . The method of any one of claims 1 , 2 , 4 and 5 wherein the dose of SFP is administered into the circulation at a dose ranging 2.4 mg to 48 mg iron per day at a rate of 0.1 to 2 mg iron per hour.

10 . The method of any one of the preceding claims, wherein the dose of ESA administered to the patient after SFP administration is at least 70% less than the dose of ESA administered prior to SFP administration.

11 . The method of any of the preceding claims wherein the SFP comprises iron chelated with citrate and pyrophosphate.

12 . The method of any of the preceding claims wherein the SFP comprises iron in an amount of 7% to 11% by weight, citrate in an amount of at least 14% by weight, and pyrophosphate in an amount of at least 10% by weight.

13 . The method of any of the preceding claims wherein the SFP is administered via dialysate and the dose of intravenously administered iron after SFP administration is at least 10% less than the dose of intravenously administered iron prior to SFP administration.

14 . The method of any of the preceding claims wherein the patient is suffering from chronic kidney disease, optionally stage III, IV or V.

15 . The method of any of the preceding claims wherein the patient is suffering from stage IV or V chronic kidney disease.

16 . The method of any of the preceding claims wherein the patient is undergoing hemodialysis.

17 . The method of any of the preceding claims wherein the patient is suffering from anemia of inflammation.

18 . The method of any of the preceding claims wherein the patient is suffering from infection, optionally chronic infection.

19 . The method of any one of the preceding claims wherein the patient is suffering from cancer, heart failure, autoimmune disease, sickle cell disease, thalassemia, blood loss, transfusion reaction, diabetes, vitamin B12 deficiency, collagen vascular disease, thrombocytopenic purpura, Celiac disease, endocrine deficiency state, hypothyroidism, Addison's disease, Crohn's Disease, systemic lupus erythematosis, rheumatoid arthritis, juvenile rheumatoid arthritis, ulcerative colitis, immune disorders, eosinophilic fasciitis, hypoimmunoglobulinemia, thrymoma/thymic carcinoma, graft vs. host disease, preleukemia, Nonhematologic syndrome, Felty syndrome, hemolytic uremic syndrome, myelodysplasic syndrome, nocturnal paroxysmal hemoglobinuria, osteomyelofibrosis, pancytopenia, pure red-cell aplasia, Schoenlein-Henoch purpura, malaria, protein starvation, menorrhagia, systemic sclerosis, liver cirrhosis, hypometabolic states, congestive heart failure, chronic infection, HIV/AIDS, tuberculosis, osteomyelitis, hepatitis B, hepatitis C, Epstein-bar virus, parvovirus, T cell leukemia virus, bacterial overgrowth syndrome, red cell membrane disorder, hereditary spherocytosis, hereditary elliptocytosis, red cell enzyme defects, hypersplenism, immune hemolysis or paroxysmal nocturnal hemoglobinuria.

20 . The method of any one of the preceding claims wherein dose of SFP is administered during hemodialysis within the hemodialysate solution.

21 . The method of any of the preceding claims wherein SFP is administered during peritoneal dialysis within the peritoneal dialysis solution.

22 . The method of any one of the preceding claims wherein SFP is administered with parenteral nutrition within parenteral nutrition admixture.

23 . The method of any one of the preceding claims wherein SFP is administered at a therapeutically effective dose that i) increases at least one marker of iron status selected from the group consisting of serum iron, transferrin saturation, reticulocyte hemoglobin, serum ferritin, reticulocyte count, and whole blood hemoglobin and ii) decreases the dose of ESA required to achieve or maintain target hemoglobin levels, or the need for transfusion of whole blood, packed red blood cell or blood substitutes.

24 . The method of claim 23 , wherein the patient is suffering from non-anemic iron deficiency and administration of the therapeutically effective dose of SFP reduces fatigue, increases physical and cognitive ability, or improves exercise tolerance in the patient.

25 . The method of any one of the preceding claims wherein SFP is administered in a therapeutically effective dose that will reduce or abolish the clinical manifestations of restless leg syndrome associated with iron