Bolus intraperitoneal iron versus intravenous iron in peritoneal dialysis patients: a prospective study

Abstract

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.

Effectiveness and safety of ferric carboxymaltose therapy in peritoneal dialysis patients: an observational study

“…Iron therapies include intravenous (IV) and oral routes of administration, the latter being frequently associated with gastrointestinal side effects and poor compliance, as well as poor gastrointestinal absorption and availability in CKD. In a randomized, cross-over study, the intraperitoneal route was proven inefficient and was therefore not recommended in PD patients [ 6 ]. IV iron use is advisable as first-line treatment in patients on dialysis or after an unsuccessful oral iron trial in non-dialysis patients (ND-CKD).…”

Anemia in Peritoneal Dialysis Patients; Iron Repletion, Current and Future Therapies

“…This process might depend on simple diffusion along a concentration gradient, convective forces during solute drag, or possibly via as yet unclassified channels, such as aquaporins. However, from previous studies in our lab, there was no measurable benefit of administering iron via this route (30). In the current issue, Shetty A et al (31) describe a pilot animal study to determine the absorption of soluble ferric pyrophosphate (SFP) iron from the peritoneal cavity and its toxicity to the peritoneum in 7 New Zealand white rabbits subjected to single PD exchanges with 4.25% Dianeal (Baxter Healthcare, Deerfield, IL, USA) containing 5 mg/L iron on days 14, 21, and 28.…”