SUMMARY Hemodialysis patients require parenteral iron to replenish/maintain sufficient iron stores and optimize erythropoietin (EPO) use. Two parenteral iron preparations are available in the UK, iron dextran (CosmoFer) and iron sucrose (Venofer). Debate about their safety profiles continues. We performed an observational study of chronic kidney disease patients and a prospective crossover study in hemodialysis patients to examine the comparative safety and tolerability of CosmoFer and Venofer. Side effects, hemoglobin, ferritin and EPO dose were recorded. One hundred and forty‐four patients received CosmoFer (2294 doses) and 110 received Venofer (2111 doses). Fifteen reactions occurred with no anaphylactic episodes in either group. Thirty‐nine patients (28 men), mean age 60.5 years, on intravenous Venofer were converted to CosmoFer for 6 months. They were then converted back to Venofer. No differences in hemoglobin, EPO dose or ferritin levels throughout the study were observed. Side effects were minor after 546 and 507 doses of CosmoFer and Venofer (13 reactions (eight CosmoFer, five Venofer) occurred in eight patients). Conversion from Venofer to CosmoFer led to a cost saving of £77 per patient over the 6‐month study period. In this study, the two forms of therapy were equally safe and effective. Examination of a larger cohort of patients is necessary to verify these findings and potentially reassess European Best Practice Guidelines.
SUMMARY Anemia in peritoneal dialysis (PD) is related to impaired erythropoiesis and/or iron deficiency. Oral iron is insufficient to supply adequate accessible iron to patients with end‐stage renal failure. Intermittent intravenous (IV) iron supplementation is effective but inconvenient in PD patients. Intraperitoneal (IP) iron may present a more convenient method of administration. In this study, we examined the efficacy of IP iron dextran in comparison with IV iron. Prospective randomized and crossover studies were carried out. Patients with a serum ferritin less than 200 µg/L, with no contraindications, were randomized to receive either IP or IV iron. Patients randomized to IP iron were subsequently crossed over to receive IV iron. Analysis using the t‐test and Mann–Whitney U test of 16 patients (12 IP and 15 IV) was performed. IP iron did not produce an increase in storage or utilizable iron in PD patients. Hemoglobin (Hb) concentrations and erythropoietin (EPO) dose were unaffected. IV iron produced a significant increase in both circulating and storage iron, with a significant rise in Hb concentrations and no change in EPO requirements. No adverse events occurred after a total of 81 doses of iron therapy. These data suggest that IP iron in this group of patients offers no clinical efficacy in PD patients.
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