Iron status and iron supplementation in peritoneal dialysis patients

Abstract

Iron status and iron supplementation in peritoneal dialysisextent of iron loss and therefore a lower incidence of patients. Iron deficiency represents an important problem in iron deficiency during peritoneal dialysis treatment may peritoneal dialysis patients, especially during erythropoietin be one reason for the reported differences [8, 9]. Hocken therapy. A combination of serum ferritin, transferrin saturation, and Marwah found a mean blood loss into the dialyzer and/or the percentage of hypochromic red cells should be used of 9 ml per hemodialysis treatment, resulting in a total to assess iron status in peritoneal dialysis patients. Primarily, oral iron supplementation should be the preferred therapy. blood loss of 1400 ml per year [10]. Furthermore, blood However, most of the studies using oral substitution in erythroloss for laboratory investigations was 1.14 to 3.22 liter/ poietin-treated peritoneal dialysis patients show a progressive year for center-treated hemodialysis patients, but was decline of serum ferritin. Therefore, parenteral iron suppleonly 0.17 liter/year for home-treated hemodialysis pamentation is required in part of the patients, and the intravenous route should be preferred in these cases. Intravenous iron tients. The reported blood losses correspond to a loss of therapy is recommended if serum ferritin falls below 100 g/ elemental iron of up to 830 mg/year in hemodialysis liter and should be stopped if the serum ferritin level is more patients not receiving erythropoietin therapy. Milman than 650 g/liter. The optimal form of intravenous iron suppleestimated an iatrogenic blood loss of 150 to 200 ml per mentation is still unclear. Injections once to three times per month for hemodialysis patients, as compared with only week restrict the patients' flexibility, but application of higher doses in longer intervals may lead to an impairment of neutro-30 to 60 ml/month for peritoneal dialysis patients [11].phil functions, probably connected to a higher risk of infection.Despite the lesser extent of blood loss, there is much We treated 17 stable peritoneal dialysis patients with 100 or evidence from clinical experience that iron deficiency 200 mg iron saccharate monthly over a period of six months also plays a main role in peritoneal dialysis patients. In and found an increase of transferrin saturation (from 12.1 Ϯ 1.6 a study published by Blumberg, Marti and Graber, eight to 20.9 Ϯ 2.4%, P ϭ 0.026), serum ferritin (from 100.4 Ϯ 32.0 to 372.4 Ϯ 54.6 g/liter, NS) and hematocrit (from 32.0 Ϯ 0.8% of 20 continuous ambulatory peritoneal dialysis (CAPD) to 35.1 Ϯ 0.9%, P ϭ 0.099). The required erythropoietin dosage patients receiving neither iron nor erythropoietin supplecould be reduced significantly (from 148.4 Ϯ 30.3 to 69.4 Ϯ mentation had diminished bone marrow iron stores [2].19.5 U/kg/week, P ϭ 0.025). Side effects occurred in 0.9% after Another study of non-erythropoietin-treated peritoneal application of 100 mg and in 5.9% after injection of 200 mg iron saccharate. The incidence of catheter...

Comparison of Adverse-Event Profiles of Intravenous Low-Molecular-Weight Iron Dextran and Iron Sucrose in Peritoneal Dialysis Patients

“…Another small study comprising 17 chronic PD patients found adverse reaction rates of 0.9% and 5.9% for 100 mg and 200 mg infusions of iron sucrose, respectively. 15 In their randomized controlled trial, Li and Wang 16 randomized 46 PD patients into intravenous iron sucrose (26 patients, 200 mg iron sucrose per week) and oral ferrous succinate 300 mg three times a day. After 8 weeks of treatment, there were no adverse events with intravenous iron.…”

Pharmacokinetic Study of Ferumoxytol: A New Iron Replacement Therapy in Normal Subjects and Hemodialysis Patients

“…In addition, only 27 anaphylactoid reactions were reported among an estimated 450,000 exposed patients between 1992 and 1999 from the spontaneous reporting system [20]. However, adverse reactions including hypotension, back pain, vomiting, or vertigo have been reported in 0.9% of patients receiving 100-mg doses of iron sucrose and in 5.9% of patients receiving 200-mg doses (non-approved dose) of iron sucrose [21]. In a study including even higher doses of iron sucrose, 36% of the 22 patients given 500 mg of iron sucrose diluted in 250 ml of saline as a 2-hour infusion had hypotension, 2 requiring hospitalization [35].…”

“…In a study including even higher doses of iron sucrose, 36% of the 22 patients given 500 mg of iron sucrose diluted in 250 ml of saline as a 2-hour infusion had hypotension, 2 requiring hospitalization [35]. These reactions, especially hypotension, may be due to rate of administration and total dose administered [20, 21]. These rate- and dose-related adverse reactions cannot be overlooked despite the excellent safety record of iron sucrose and low incidence of serious reactions at the labeled dose of 100 mg of iron [36].…”

“…Although serious and life-threatening reactions occur most frequently with iron dextran [18], they do occur rarely with iron gluconate and iron sucrose [19, 20]. In addition, non-life-threatening reactions such as hypotension, back pain, vomiting, vertigo, and pruritus also occur with the gluconate and sucrose formulations and may be related to the rate of administration [20, 21]. These reactions, although not life-threatening, will sometimes preclude further dosing and therefore iron repletion [19,22,23,24].…”

Safety Issues With Intravenous Iron Products in the Management of Anemia in Chronic Kidney Disease

“…Based on the 2005 U.S. Renal Data System Annual Report, approximately 70% of hemodialysis patients in the United States receive parenteral iron. 26 Intravenous iron therapy unequivocally is superior to oral iron supplementation in hemodialysis patients, 27-29 peritoneal dialysis patients, [30][31][32] and patients with CKD. 33,34 Intravenous iron agents that currently are available in North America include only iron sucrose (Venofer), ferric gluconate (Ferrlecit), and two iron dextran (INFeD, Dexferrum) formulations 24 (table 2).…”