Intravenous iron supplementation for the treatment of the anemia of moderate to severe chronic renal failure patients not receiving dialysis

Silverberg, Donald S.; Iaina, Adrian; Peer, G; Kaplan, Eliezer; Levi, Bat Ami; Frank, N. R.; Steinbruch, Shoshana; Blum, Miriam

doi:10.1016/s0272-6386(96)90546-6

Cited by 157 publications

(112 citation statements)

References 18 publications

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“…49 Patients treated with intravenous iron (100 mg twice weekly) achieved a 46% reduction in ESA dosage required to maintain hematocrit (Hct) levels between 30% and 34%, compared with patients supplemented with oral iron. 50 To further address the management of iron-restricted erythropoiesis in chronic kidney disease patients undergoing dialysis, a randomized controlled trial evaluated the efficacy of intravenous iron supplementation in patients with ferritin between 500 and 1200 ng/mL. 51 The administration of intravenous iron (and increasing the dose of ESA by 25%) resulted in a greater correction of anemia compared with increasing the dose of ESA alone.…”

Section: Intravenous Iron Therapymentioning

confidence: 99%

Detection, evaluation, and management of iron-restricted erythropoiesis

Goodnough

Nemeth

Ganz

2010

Blood

378

349

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Section: Intravenous Iron Therapymentioning

confidence: 99%

Detection, evaluation, and management of iron-restricted erythropoiesis

Goodnough

Nemeth

Ganz

2010

Blood

378

349

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“…It also had long been used in Europe, lacked a dextran coat, and was reported to have a safety profile similar to FG. 17 Black box warnings do not appear in the package inserts of either FG or IS, and a test dose was not recommended. Subsequently FG and IS largely replaced the use of iron dextrans in US dialysis patients.…”

Section: History Of IV Ironmentioning

confidence: 99%

Clinical Use of Intravenous Iron: Administration, Efficacy, and Safety

2010

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This section reviews the history, pharmacology, administration, efficacy, and toxicity of intravenous iron. Intravenous iron offers advantages over oral iron for the treatment of iron deficiency anemia across a wide range of disease states associated with absolute and functional iron deficiency. However, there remain concerns about the acute safety profiles of the available preparations and the potential for long-term toxicity with their repeated administration. Seven intravenous iron formulations are available. Confusion concerning the relative toxicities of the different formulations abounds. The similarities and differences are discussed. Iron repletion has been associated with adverse outcomes in infections. The relationship, if any, between intravenous iron administration and infections is reviewed. The potential advantages of total dose infusion (TDI), complete repletion in a single setting, are highlighted. A new paradigm for iron replacement therapy in iron deficiency anemia is presented.

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“…On the other hand, numerous patients with a TSAT greater than 20% have functional iron deficiency respond to increased iron doses with elevations in the haematocrit, or maintenance of their haematocrit at decreased erythropoietin doses. [25][26][27][28] In our study, 43 patients had low TSAT (<20%); only 25 of them had iron deficiency (combined with ferritin). We found that 57 patients had TSAT values more than 20%, out of which 11 had low ferritin (<200).…”

Section: Discussionmentioning

confidence: 46%

“…Similarly, a transferrin saturation of less than 20% in patients on haemodialysis is considered to be suggestive of iron deficiency whereas other studies have suggested that a transferrin saturation < 20% versus >20% alone may be inaccurate for assessing iron deficiency. [23][24][25][26][27][28] While most patients with TSAT less than 20% are iron deficient, few patients don't respond to an increase in iron supplements with either increase in haematocrit or maintenance of haematocrit with a decreased ESA requirement. On the other hand, numerous patients with a TSAT greater than 20% have functional iron deficiency respond to increased iron doses with elevations in the haematocrit, or maintenance of their haematocrit at decreased erythropoietin doses.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of iron status in patients with end stage renal disease

et al. 2017

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Background: Anaemia is almost universal in haemodialysis patients. Here, we evaluated the utility and clinical implications of the commonly employed tests in assessing iron status in haemodialysis patients.Methods: In this prospective observational study, we enrolled 100 prevalent haemodialysis patients, and measured transferrin saturation (TSAT) and serum ferritin at enrolment. Patients were categorized to have normal, deficient, overload, or indeterminate status of iron based on KDOQI guidelines. To study anaemia trend, haemoglobin (Hb) level at time of enrolment, as well as levels 3-months before and 3-months after enrolment, were collected. Patient survival outcomes were also obtained till October 2016.Results: Using serum ferritin and TSAT, iron status was determinable in 48% of the patients ie 20%-normal iron status, 25% - iron deficiency, 3% - iron overload. Fifty-two percent of the patients’ iron status was indeterminate by current parameters. In spite of being on standard-of-care treatment in our centre, we observed that mean-Hb level of patients in the indeterminate group showed insignificant increases compared to normal- and deficient-groups. Mean delta-Hb levels over 6-months were 0.80±1.54 g/dl in the indeterminate group, compared to 1.87±1.95 g/dl in the deficient group (P=0.03). In our cohort, 57% had died and 5 lost follow-ups during the study (P=0.30 between groups).Conclusions: Serum ferritin and TSAT accurately categorized the iron status of 48% haemodialysis patients in our study. Divergent serum ferritin and TSAT values, or an iron indeterminate state was prevalent in 52% of our urban dialysis cohort. The indeterminate group had inferior increases in Hb over time with current treatment, showing clinical relevance of this finding. Our data suggests the need for more sensitive indices to accurately assess iron status, and improve anaemia management.

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Intravenous iron supplementation for the treatment of the anemia of moderate to severe chronic renal failure patients not receiving dialysis

Cited by 157 publications

References 18 publications

Detection, evaluation, and management of iron-restricted erythropoiesis

Detection, evaluation, and management of iron-restricted erythropoiesis

Clinical Use of Intravenous Iron: Administration, Efficacy, and Safety

Evaluation of iron status in patients with end stage renal disease

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