Intravenous iron supplementation for the treatment of anaemia in pre-dialyzed chronic renal failure patients

Mircescu, Gabriel; Gârneaţă, Liliana; Căpuşă, Cristina; Ursea, N

doi:10.1093/ndt/gfi087

Cited by 91 publications

(93 citation statements)

References 17 publications

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“…IV iron overcomes this reduced ability to absorb iron [6,20]. Used in isolation, IV iron leads to a significant rise in Hb concentrations in the order of 0.6–2.7 g/dl [21]. In our study, we saw a similar rise (fig.…”

Section: Discussionsupporting

confidence: 78%

Efficacy and Tolerability of Accelerated-Dose Low-Molecular-Weight Iron Dextran (Cosmofer) in Patients with Chronic Kidney Disease

Cooke

Lamplugh²,

Naudeer³

et al. 2011

Am J Nephrol

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Introduction: The Renal NSF advocates correction of anaemia in chronic kidney disease patients. Oral iron is often insufficient, while intravenous supplementation replenishes and maintains iron stores. There is a need to administer high doses of iron in a single rapid infusion to enable efficient costs, effective utilisation of time for patients and staff and optimal use of resources. Methods: We performed a prospective study of consecutive patients referred for iron dextran (Cosmofer) therapy. This was administered over 2 h 40 min compared with the normal regime of 4–6 h. Blood pressure was recorded throughout administration. Adverse drug reactions were recorded over 2 weeks. Serum ferritin, haemoglobin and estimated glomerular filtration rate were measured at baseline and 3 months. Results: One hundred patients (59 male, mean age 69 years), received a median dose of 1,000 mg Cosmofer in a median time of 2 h 40 min. Mean serum ferritin rose from 178 at baseline to 413 µg/l (p < 0.001). Mean haemoglobin rose by 1.5 g/dl (p < 0.001). There was no decline in estimated glomerular filtration rate after 3 months. No adverse reactions were noted. Conclusion: We demonstrated that accelerated administration of iron dextran is safe and effective with no short-term effects on renal function. This resulted in a time saving of approximately 67 hours.

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Section: Discussionsupporting

confidence: 78%

Efficacy and Tolerability of Accelerated-Dose Low-Molecular-Weight Iron Dextran (Cosmofer) in Patients with Chronic Kidney Disease

Cooke

Lamplugh²,

Naudeer³

et al. 2011

Am J Nephrol

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“…In patients with CKD who are anemic but not in CHF, IV iron alone may also increase the Hb level significantly [66,67,68,69], discouraging the use of ESA altogether in many cases. Although there has been concern about IV iron causing renal disease [70], this has not been confirmed by most studies [58,66,68,69].…”

Section: The Effect Of IV Iron Alone In the Anemia Of Chfmentioning

confidence: 99%

“…Although there has been concern about IV iron causing renal disease [70], this has not been confirmed by most studies [58,66,68,69]. However, IV iron can cause oxidative stress [71], and therefore long-term controlled studies of IV iron are needed to evaluate the effects of IV iron in CKD, as in CHF.…”

Section: The Effect Of IV Iron Alone In the Anemia Of Chfmentioning

confidence: 99%

The Anemia of Heart Failure

Silverberg¹,

Wexler²,

Palazzuoli³

et al. 2009

Acta Haematol

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Anemia is common in congestive heart failure (CHF) and is associated with an increased mortality and morbidity. The most likely causes of anemia are chronic kidney disease (CKD) and excessive cytokine production, both of which can cause depression of erythropoietin (EPO) production and bone marrow activity. The cytokines also induce iron deficiency by both reducing gastrointestinal iron absorption and iron release from iron stores located in the macrophages and hepatocytes. Iron deficiency can cause thrombocytosis which might also contribute to cardiovascular complications in both CHF and CKD and is partially reversible with iron treatment. Thus attempts to control this anemia will have to consider both the use of erythropoiesis-stimulating agents (ESA), such as EPO, as well as oral and, probably more importantly, intravenous (IV) iron. The many studies on anemia in CHF patients treated with ESA and oral or IV iron, and even with IV iron without ESA have up to now shown a quite consistent positive effect on hospitalization, fatigue, shortness of breath, quality of life, exercise capacity, and β-natriuretic peptide reduction, in the absence of increased cardiovascular damage related to the therapy. Adequately powered long-term placebo-controlled studies of ESA and/or IV iron are currently being carried out and their results are eagerly awaited.

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“…Because MCP-1 has profibrotic properties, negative implications for CKD progression by intravenous iron products have been suggested (100). In patients with CKD, intravenous administration of 100 mg of iron sucrose caused transient proteinuria and urinary excretion (104). In addition, van Wyck et al (52) showed that intravenous iron is at least as safe as oral iron in preserving GFR in anemic patients with CKD.…”

Section: Critical Evaluation Of the Risk Of Iron Administrationmentioning

confidence: 99%