Iron sucrose causes greater proteinuria than ferric gluconate in non-dialysis chronic kidney disease

Abstract

Non-dextran intravenous (i.v.) iron preparations seem to differentially affect proteinuria in patients with chronic kidney disease. To study effects of ferric gluconate and iron sucrose on proteinuria, we conducted a crossover trial in 12 patients with stage 3-4 chronic kidney disease. These patients were randomized to receive the same dose of either drug 1 week apart. Urine samples were obtained immediately before and at frequent intervals after the drug. The urine total protein/creatinine ratio was significantly greater after iron sucrose than ferric gluconate treatment with the effect noted within 15 min post-infusion. Furthermore, when iron sucrose was given first, a significantly greater protein/creatinine ratio was seen subsequently with ferric gluconate than with the reverse order of treatment. The urine albumin/creatinine ratio was also significantly greater with iron sucrose than with ferric gluconate. There was no significant difference, however, between the two i.v. irons in the measured urine N-acetyl-beta-D-glucosaminidase/creatinine ratio. Although our study showed that acutely, iron sucrose increased proteinuria, the long-term effects of repeated i.v. non-dextran iron on kidney function requires further study.

Proteinuria Induced by Parenteral Iron in Chronic Kidney Disease—A Comparative Randomized Controlled Trial

“…On the other hand, ferric gluconate at two dosage levels (125 and 250 mg) administered to iron-deficient anemic patients with CKD found that although ferric gluconate caused oxidative stress, there was no evidence of acute renal injury (12). In our earlier crossover, randomized, single-dose exposure trial comparing ferric gluconate to iron sucrose, we demonstrated that the urine total protein-to-creatinine ratio was significantly greater after iron sucrose than ferric gluconate treatment with the effect noted within 15 minutes after infusion (13). Furthermore, when iron sucrose was given first, a significantly greater protein-to-creatinine ratio was seen subsequently with ferric gluconate than with the reverse order of treatment.…”

“…Although iron sucrose was associated with worsening of proteinuria, ferric gluconate was not (11,12). In a single dose head-to-head comparison of iron sucrose and ferric gluconate, iron sucrose was found to elicit greater proteinuria (13). Because proteinuria is strongly linked to accelerated progression to ESRD and cardiovascular disease, concerns regarding IV iron have been raised in the long term (6).…”

Pharmacologic Adjuvants to Reduce Erythropoietin Therapy Dose in Anemia of Chronic Kidney Disease and End Stage Renal Disease

“…Oral iron has more GI associated side effects including constipation, diarrhea, nausea and vomiting. [13][14][15][16][17] As a result of these studies the K/DOQI guidelines have recommended that either oral iron therapy or intravenous iron therapy can be given in CKD patients.…”

“…Both oral and IV iron similarly increased Hb in anemic CKD patients not receiving ESAs. 16 A new IV iron preparation, ferumoxytol has been approved in the United States. It appears to be safe and effective when given as a rapid infusion of up to 510 mg in patients with CKD and patients on dialysis.…”

“…12 A number of clinical trials have compared which route of iron administration Intravenous (IV) vs Oral (PO) is superior in treating anemia of CKD. [13][14][15][16][17][18][19][20][21][22] First we will discuss this issue in the Chronic Kidney Disease (CKD) population.…”