A Randomized Controlled Trial of Intravenous or Oral Iron for Posttransplant Anemia in Kidney Transplantation

Mudge, David W.; Tan, Ken‐Soon; Miles, Rhianna; Johnson, David W.; Badve, Sunil V.; Campbell, Scott; Isbel, Nicole M.; Eps, C. L. Van; Hawley, Carmel M.

doi:10.1097/tp.0b013e318248375a

Cited by 37 publications

(47 citation statements)

References 11 publications

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“…TSAT and serum ferritin level are used as iron metabolism markers for grafts as in CKD patients, although their effectiveness in an inflammatory environment due to infections and rejection episodes is questioned [274,275]. One report showed that there was no significant difference between the efficacy of oral and intravenous iron supplementation for PTA patients [276]. For details about administration methods, readers should refer to Chapter 4 ("Evaluation of iron status and iron therapy") of these guidelines.…”

Section: Rationalementioning

confidence: 99%

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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Section: Rationalementioning

confidence: 99%

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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“…A recent randomized controlled trial of iron supplementation found no difference between per oral and intravenous route with regard to restoration of Hb‐levels to >11 g/dl postoperatively, but long term iron supplementation has not been investigated in controlled trials [73]. Except for a recent trial on Hb‐correction by ESA therapy [85], there is no randomized controlled study of sufficient size that allows definitive answers to questions as: when to treat, how to treat and to which levels, Hb‐values should be raised.…”

mentioning

confidence: 99%

Anemia and Erythrocytosis in patients after kidney transplantation

Małyszko¹,

Oberbauer²,

Watschinger³

2012

Transplant International

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Summary Anemia is a highly prevalent disorder in recipients of renal allografts. Despite its frequent occurrence, there is still uncertainty with regard to treatment targets and treatment options. This includes questions on appropriate iron management, the choice and dosage of erythropoietin stimulating agents, criteria for the timing of treatment initiation and the targeted hemoglobin values. The review summarizes available data on recent therapeutic strategies for post‐trasnplant anemia, as well as for post transplant erythrocytosis, another hematological disorder, that has decreased in recent years.

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“…With impaired iron uptake from the gastrointestinal tract (in anemia of chronic disease (ACD) [3] or after bariatric surgery), suboptimal responsiveness to exogenous erythropoietin (in chronic renal failure) [4], in patients with cancer receiving chemotherapy [5], or when oral iron is poorly tolerated, IV iron therapy is the preferred mode of repletion [2,5]. Although effective in increasing hemoglobin [6][7][8][9][10], the relative safety of the available IV iron preparations is not well documented. We examined the comparative safety of IV iron formulations used at hospitals associated with our institution.…”

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confidence: 99%

Comparative rates of adverse events with different formulations of intravenous iron

et al. 2012

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Oral iron replacement is the standard therapy in iron-deficiency anemia (IDA) [1]. However, 59% of patients have gastrointestinal toxicity [2]. With impaired iron uptake from the gastrointestinal tract (in anemia of chronic disease (ACD) [3] or after bariatric surgery), suboptimal responsiveness to exogenous erythropoietin (in chronic renal failure) [4], in patients with cancer receiving chemotherapy [5], or when oral iron is poorly tolerated, IV iron therapy is the preferred mode of repletion [2,5]. Although effective in increasing hemoglobin [6][7][8][9][10], the relative safety of the available IV iron preparations is not well documented. We examined the comparative safety of IV iron formulations used at hospitals associated with our institution. Among 619 unique patients who received IV iron over a 2-year period, we found 32 adverse events (AEs), ranging from urticaria to chest pain. There were no serious AEs or anaphylactic-type reactions. In a multivariate model, there was no difference in AE rates between low-molecular-weight iron dextran (LMWD) and ferric gluconate; however, iron sucrose had significantly higher odds ratio of AEs (OR 5 5.7; 95% CI 5 1.6-21.3). Our data suggest that AE rates with IV iron are acceptable. More widespread use of LMWD, in particular, which can be given safely as a total dose infusion (TDI), should be considered.Five formulations of IV iron are approved by the United States Food and Drug Administration: LMWD (INFeD in the United States; approved at 100 mg dose), high-molecular-weight iron dextran (HMWD or Dexferrum; approved at 100 mg dose), ferric gluconate (Ferrlecit; approved at 125 mg dose, given over eight sessions for 1 g), iron sucrose (Venofer; approved at 100-400 mg dose, given in three or more sessions for 1 g), and ferumoxytol (Feraheme; approved at 510 mg dose, given in two sessions for 1 g). LMWD, although approved in the United States at 100 mg dose, can be given safely as a TDI of 1 g or more in one session.During the 2-year study period, 619 unique patients received at least one treatment cycle of IV iron. A total of 3,174 infusions of IV iron were given. The mean age of patients was 50.7 years; 81.1% were women and 70.6% were White. Four hundred seventy-eight patients (77.2%) were seen at a tertiary center and 470 (75.9%) were treated for IDA. Three hundred ninetythree patients (63.5%) received ferric gluconate, 121 patients (19.5%) received LMWD, 96 patients (15.5%) received iron sucrose, and nine patients (1.5%) received HMWD. Ferumoxytol was not used at our institution hospitals during the years of this study. A total of 32 AEs were reported in association with IV iron. AEs were seen in 14 patients who received ferric gluconate, three patients who received LMWD, 11 patients who received iron sucrose and four of those treated with HMWD (see Table I). All AEs were mild or moderate and included urticaria/rash, facial flushing, lip numbness, lightheadedness, nausea, swelling/erythema at the injection site, rigors, fevers, and chest pain (see Table II). No sever...

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A Randomized Controlled Trial of Intravenous or Oral Iron for Posttransplant Anemia in Kidney Transplantation

Abstract: We conclude that a single dose of IV iron did not result in more rapid resolution of anemia compared with PO iron. Both IV and PO iron are safe and effective in the management of posttransplant anemia.

Cited by 37 publications

References 11 publications

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Anemia and Erythrocytosis in patients after kidney transplantation

Comparative rates of adverse events with different formulations of intravenous iron

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