Safety of total dose iron dextran infusion in geriatric patients with chronic kidney disease and iron deficiency anemia

Abstract

There are limited data on total dose infusion (TDI) using iron dextran in geriatric chronic kidney disease (CKD) patients with iron-deficiency anemia (IDA). Our goal was to evaluate the safety of TDI in this setting. We conducted a retrospective chart review spanning a 5 year period (2002-2007), including all patients with CKD and IDA who were treated with iron dextran TDI. Patient demographics were noted, and laboratory values for creatinine, hemoglobin and iron stores were recorded pre- and post-dose. TDI diluted in normal saline was administered intravenously over 4-6 hours after an initial test dose. One hundred fifty-three patients received a total of 250 doses of TDI (mean ± SD=971 ± 175 mg); age was 69 ± 12 years and creatinine 3.3 ± 1.9 mg/dL. All stages of CKD were represented (stage 4 commonest). Hemoglobin and iron stores improved post-TDI (P<0.001). None of the patients experienced an anaphylactic reaction or death. Adverse events (AEs) were noted in 8 out of 250 administered doses (3.2%). The most common AEs were itching, chills and back pain. One hundred and ten doses of high molecular weight (HMW) iron dextran produced 6 AEs (5.45%), whereas 140 doses of low molecular weight (LMW) iron dextran produced 2 AEs (1.43%), a non-significant trend (P=0.1433 by Fishers Exact Test). Iron dextran TDI is relatively safe and effective in correcting IDA in geriatric CKD patients. Fewer AEs were noted with the LMW compared to the HMW product. LMW iron dextran given as TDI can save both cost and time, helping to alleviate issues of non-compliance and patient scheduling.

Efficacy and Safety of Intravenous Ferric Carboxymaltose in Geriatric Inpatients at a German Tertiary University Teaching Hospital: A Retrospective Observational Cohort Study of Clinical Practice

“…iron as FCM. These findings compare favourably with data published recently by Dossabhoy et al [ 28 ].…”

“…While safety data for i.v. iron supplementation in geriatric patients are scarce, a recent retrospective study by Dossabhoy demonstrated iron dextran to be relatively safe and effective in elderly patients (mean, 70 years) with chronic kidney disease [ 28 ].…”

“…administration in individual doses up to 1000 mg and has been demonstrated to be safe and highly effective in the treatment of both mild and severe IDA in a large cohort of patients up to 70 years of age [ 29 ]. Apart from two recently published heterogenous chart analyses [ 28 , 30 ], however, no data exist for patients over 70 years of age. Here, we report results of a monocentric retrospective chart data analysis designed to assess the safety and efficacy of i.v.…”

Large-scale Isolation of Highly Pure “Untouched” Regulatory T Cells in a GMP Environment for Adoptive Cell Therapy

“…Similar particles, for example, iron-carbohydrate solutions or iron-dextran, have been used in humans for anemia treatment with a good safety profile. 29,30 We could show that these "untouched" Treg cells are also functional as they were able to suppress proliferation of autologous CD4 Teff cells. The degree of suppressive capacity showed considerable variability; this is not necessarily exclusively due to quantitative variations in the functional status of the Treg cells.…”

Dextran Aldehyde in Biocatalysis: More Than a Mere Immobilization System

“…Finally, it is worth mentioning the use of dextran-hemoglobin conjugates as blood substitutes for patients suffering from asthma or other hemoglobin-compromised conditions. These dextran derivatives not only increase the therapeutic efficiency by enhancing the binding and release of oxygen [111][112][113][114], but also prevent hemoglobin excretion (avoiding any kidney damage [115,116]), reduce the non-renal clearance of hemoglobin (therefore minimizing risks of tissue edema [117]) and reduce the auto-oxidation described for other hemoglobin-based oxygen carriers (reducing tissue and cellular toxicity [118]).…”