Sodium ferric gluconate for post‐transplant anemia in pediatric and young adult renal transplant recipients

Gillespie, Robert S.; Symons, Jordan M.

doi:10.1111/j.1399-3046.2005.00258.x

Cited by 15 publications

(9 citation statements)

References 9 publications

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“…The mean hemoglobin level increased significantly from 10.1 ± 1.6 to 11.4 ± 2.1 g/dl following ferric gluconate therapy. Adverse events were observed in three children [106]. A recent study by Morii and coworkers showed that oral coadministration of ferrous sulphate markedly decreased the absorption of mycophenolate mofetil in healthy Japanese subjects [107].…”

Section: Iron Therapy After Kidney Transplantationmentioning

confidence: 99%

Iron therapy for renal anemia: how much needed, how much harmful?

Hörl

2007

Pediatr Nephrol

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Iron deficiency is the most common cause of hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) in end-stage renal disease (ESRD) patients. Iron deficiency can easily be corrected by intravenous iron administration, which is more effective than oral iron supplementation, at least in adult patients with chronic kidney disease (CKD). Iron status can be monitored by different parameters such as ferritin, transferrin saturation, percentage of hypochromic red blood cells, and/or the reticulocyte hemoglobin content, but an increased erythropoietic response to iron supplementation is the most widely accepted reference standard of iron-deficient erythropoiesis. Parenteral iron therapy is not without acute and chronic adverse events. While provocative animal and in vitro studies suggest induction of inflammation, oxidative stress, and kidney damage by available parenteral iron preparations, several recent clinical studies showed the opposite effects as long as intravenous iron was adequately dosed. Thus, within the recommended international guidelines, parenteral iron administration is safe. Intravenous iron therapy should be withheld during acute infection but not during inflammation. The integration of ESA and intravenous iron therapy into anemia management allowed attainment of target hemoglobin values in the majority of pediatric and adult CKD and ESRD patients.

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Section: Iron Therapy After Kidney Transplantationmentioning

confidence: 99%

Iron therapy for renal anemia: how much needed, how much harmful?

Hörl

2007

Pediatr Nephrol

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“…Warady et al recommended that the starting dose of IV sodium ferric gluconate (SFG) complex be 1.0 mg/kg, not to exceed 125 mg, with adjustments made according to TSAT and/or serum ferritin levels [52]. Gillespie et al analyzed data from 14 pediatric renal transplant recipients who received SFG for PTA during a 28-month period [56]. Patients received one to six doses of SFG to yield a total dose of 100–1000 mg or 2.7–23.7 mg/kg.…”

Section: Approach To Posttransplantation Anemia Managementmentioning

confidence: 99%

Understanding renal posttransplantation anemia in the pediatric population

Galutira

Río

2011

Pediatr Nephrol

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Advances in renal transplantation management have proven to be beneficial in improving graft and patient survival. One of the properties of a well-functioning renal allograft is the secretion of adequate amounts of the hormone erythropoietin to stimulate erythropoiesis. Posttransplantation anemia (PTA) may occur at any point in time following transplantation, and the cause is multifactoral. Much of our understanding of PTA is based on studies of adult transplant recipients. The limited number of studies that have been reported on pediatric renal transplant patients appear to indicate that PTA is prevalent in this patient population. Erythropoietin deficiency or resistance is commonly associated with iron deficiency. An understanding of the risk factors, pathophysiology and management of PTA in the pediatric renal transplant population may provide guidelines for clinicians and researchers in the pursuit of larger prospective randomized control studies aimed at improving our limited knowledge of PTA. Recognition of PTA through regular screening and evaluation of the multiple factors that may contribute to its development are recommended after transplantation.

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“…In a retrospective case series, Gillespie and Symonds used intravenous ferrous gluconate to treat 15 paediatric and young adult renal transplant recipients and found that doses of up to 250 mg induced a statistically significant increase in mean haemoglobin levels. There were only 4 adverse events reported in 3 patients, all self limiting and none life threatening [8]. However, there are no trials to date comparing the efficacy of intravenous versus oral iron replacement.…”

Section: Introductionmentioning

confidence: 99%

Intravenous versus oral iron supplementation for correction of post-transplant anaemia in renal transplant patients

et al. 2009

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BackgroundPost-transplant anaemia remains a common problem after kidney transplantation, with an incidence ranging from nearly 80% at day 0 to about 25% at 1 year. It has been associated with poor graft outcome, and recently has also been shown to be associated with increased mortality.Our transplant unit routinely administers oral iron supplements to renal transplant recipients but this is frequently accompanied by side effects, mainly gastrointestinal intolerance. Intravenous iron is frequently administered to dialysis patients and we sought to investigate this mode of administration in transplant recipients after noticing less anaemia in several patients who had received intravenous iron just prior to being called in for transplantation.MethodsThis study is a single-centre, prospective, open-label, randomised, controlled trial of oral versus intravenous iron supplements in renal transplant recipients and aims to recruit approximately 100 patients over a 12-month period. Patients will be randomised to receive a single dose of 500 mg iron polymaltose (intravenous iron group) or 2 ferrous sulphate slow-release tablets daily (oral iron group). The primary outcome is time to normalisation of haemoglobin post-transplant. Prospective power calculations have indicated that a minimum of 48 patients in each group would have to be followed up for 3 months in order to have a 90% probability of detecting a halving of the time to correction of haemoglobin levels to ≥110 g/l in iron-treated patients, assuming an α of 0.05. All eligible adult patients undergoing renal transplantation at the Princess Alexandra Hospital will be offered participation in the trial. Exclusion criteria will include iron overload (transferrin saturation >50% or ferritin >800 μg/l), or previous intolerance of either oral or intravenous iron supplements.DiscussionIf the trial shows a reduction in the time to correction of anaemia with intravenous iron or less side effects than oral iron, then intravenous iron may become the standard of treatment in this patient group.

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Sodium ferric gluconate for post‐transplant anemia in pediatric and young adult renal transplant recipients

Cited by 15 publications

References 9 publications

Iron therapy for renal anemia: how much needed, how much harmful?

Iron therapy for renal anemia: how much needed, how much harmful?

Understanding renal posttransplantation anemia in the pediatric population

Intravenous versus oral iron supplementation for correction of post-transplant anaemia in renal transplant patients

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