Total Dose Iron Infusion: Safety and Efficacy in Predialysis Patients

Abstract

Iron deficiency anemia is not uncommon in predialysis patients. Oral iron often cannot maintain adequate iron stores. Hence we evaluated the safety and efficacy of total dose infusion (TDI) of iron in these patients. Anemic predialysis patients were screened and those with Hb < 7.0 g/dL and serum ferritin < 200 ng/mL were selected. Patients with active bleeding and acute liver disease were excluded. All patients were on oral iron 100 mg/day. None of the patients were on erythropoeitin. 11 patients (6 males and 5 females), aged 45.9 +/- 15 yrs, were suitable. Hb was 5.9 +/- 1.0 g/dL and serum ferritin was 89.5 + 50 ng/mL. The preparation used was iron dextran. A test dose of 25 mg in 100 mL normal saline was administered over 1 hr to all patients. One patient had fever and chills during the test dose and was not given TDI. 10 patients received TDI. None of these patients had any problem during the infusion. The dose of iron administered was 900 + 316.2 mg. One patient who received 1600 mg had arthralgia-myalgia and another patient had thrombophlebitis following TDI. One month after TDI, Hb was 8.0 + 1.0 g/dL and serum ferritin was 362 ng/mL. We feel that TDI is a safe and effective method of correcting iron deficiency in predialysis patients.

Recent experience with high-dose intravenous iron administration

“…Additionally, the GFR was maintained throughout the 6 months of observation, with no significant difference seen at 1 and 6 months (at 1 month ¼ 36.4716.6 ml/min/1.73 m 2 , and at 6 months 34.1717.4 ml/min/1.73 m 2 ). These observations confirm and extend other studies, which examined the effect of intravenous iron therapy, whether it be iron dextran, [5][6][7] sodium ferric gluconate, 8,9 or iron sucrose, [10][11][12] on hemoglobin values, in patients with CKD, without concomitant erythropoiesis-stimulating agents. The administration of a total of 1000 mg of intravenous iron resulted in about a 1 g/dl increase in hemoglobin concentration, which approximates the results in the other studies.…”

Iron deficiency anemia in patients receiving home total parenteral nutrition

“…The administration of IV iron has been used in several groups of patients in the past, including pregnant women and women who have recently given birth, 3,4 patients undergoing surgery, 5 patients undergoing hemodialysis, 6,7 and predialysis patients with chronic renal disease. 8,9 IV iron administration is also a convenient means to treat and prevent deficiency in patients receiving HPN. However, there are some limitations and concerns.…”

Erythropoietic response to oral iron in patients with nondialysis-dependent chronic kidney disease in the FIND-CKD trial

“…The observation that baseline Hb was lower in early responders is as expected. Experience with IV iron, where there is no barrier to uptake, has shown that the largest erythropoietic response occurs in patients with the most severe anemia [ 19 , 20 ]. Equally, it is intuitive that patients with the worst iron status, based on ferritin and TSAT levels, will benefit most from iron supplementation.…”