ABSTRACT
A regimen of a single high dose iron administration was initially adopted for patients commencing haemodialysis (HD) treatment. Iron stores are established and iron metabolism and erythropoiesis stabilise allowing haematinic parameters to be more confidently assessed for use in anaemia management decisions. High doses of IV iron delay the need for subsequent iron supplementation. A high-dose, low-frequency iron infusion regimen for all HD patients was adopted. The outcomes of administering this dosage regimen are reported as observational retrospective analysis using patient record data in 2009. Patients received three [median; semi-interquartile range (SIQR) 0.5] high-dose iron infusions during the year. The median infusion dose was 1100 mg iron (SIQR 0.0) and the median amount of iron received during the year by each patient was 3200 mg (SIQR 750). The median haemoglobin (Hb) level prior to infusion was 108 g/l and post infusion 114 g/l; ZHb = 2.656, p = 0.008). Ferritin levels increased from a median of 376 µg/l preinfusion to 690 µg/l postinfusion; Zferritin =-4.796, p < 0.001. The median time between infusions was 125 days (approximately four months). The 51 patients (76%) who received three or less infusions within the study period received 2537 mg (mean) of iron. These findings indicate that both Hb and ferritin levels can be adequately managed using a high-dose, low-frequency regimen of IV iron in patients undergoing HD.
Subject(s)
Ferric Compounds/administration & dosage , Kidney Failure, Chronic/therapy , Renal Dialysis , Adult , Aged , Aged, 80 and over , Anemia, Iron-Deficiency/drug therapy , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/prevention & control , Ferric Oxide, Saccharated , Glucaric Acid , Humans , Infusions, Intravenous , Middle Aged , Renal Dialysis/adverse effects , Young AdultABSTRACT
BACKGROUND: Low-molecular-weight iron dextran (CosmoFer) is the only form of parenteral iron that can be administered as a total dose infusion (TDI) in the United Kingdom (UK). This study aimed to evaluate the safety and efficacy of TDI CosmoFer in comparison to intravenous iron sucrose infusion (Venofer) in patients with chronic kidney disease (CKD). METHODS AND RESULTS: A retrospective study of outpatients with CKD undergoing intravenous TDI CosmoFer or Venofer infusion was conducted at Salford Royal Hospital and Sunderland Royal Hospital. A total of 979 doses of CosmoFer and 504 doses of Venofer were administered. There were three minor adverse events in patients receiving CosmoFer compared with one minor event in a Venofer treated patient. There were no anaphylactoid-type reactions in either group. Serum haemoglobin, ferritin and transferrin saturation (TSAT) improved significantly 4-6 months postinfusion in both treatment groups. CONCLUSION: TDI CosmoFer is an efficacious method of replenishing iron stores in CKD patients in an outpatient setting. Furthermore, TDI CosmoFer is safe and not associated with an increase in adverse events compared to Venofer.
Subject(s)
Anemia, Iron-Deficiency/drug therapy , Ferric Compounds/adverse effects , Hematinics/adverse effects , Iron-Dextran Complex/adverse effects , Renal Insufficiency, Chronic/complications , Sucrose/adverse effects , Anemia, Iron-Deficiency/etiology , Drug-Related Side Effects and Adverse Reactions , Female , Ferric Compounds/administration & dosage , Ferric Oxide, Saccharated , Glucaric Acid , Hematinics/administration & dosage , Humans , Infusions, Intravenous , Iron-Dextran Complex/administration & dosage , Male , Middle Aged , Retrospective Studies , Sucrose/administration & dosageABSTRACT
Anaemia and iron deficiency are prevalent in the Western and developing world. They have implications for quality of life, prognosis and survival in a number of clinical settings. These range from the implications of anaemic status and associated outcomes in pregnancy, reduced blood transfusion requirements following surgery to lethargy and tiredness in older people if left unrecognised and untreated. Renal medicine is at the forefront of diagnosing and treating anaemia associated with chronic renal disease. In this arena the role of intravenous (IV) iron is well established. This article describes how IV iron may be given in total doses in a short-stay hospital setting.
Subject(s)
Anemia, Iron-Deficiency/drug therapy , Day Care, Medical/organization & administration , Hematinics/administration & dosage , Hemodialysis Units, Hospital/organization & administration , Iron-Dextran Complex/administration & dosage , Kidney Failure, Chronic/complications , Algorithms , Anemia, Iron-Deficiency/epidemiology , Anemia, Iron-Deficiency/etiology , Body Weight , Clinical Protocols , Drug Administration Schedule , Drug Dosage Calculations , Drug Hypersensitivity/etiology , Drug Monitoring , Ferric Compounds , Ferric Oxide, Saccharated , Glucaric Acid , Hematinics/adverse effects , Humans , Incidence , Infusions, Intravenous/methods , Infusions, Intravenous/nursing , Iron-Dextran Complex/adverse effects , Nursing Evaluation Research , Practice Guidelines as Topic , Program Evaluation , Sucrose , Time Factors , Treatment Outcome , United Kingdom/epidemiologyABSTRACT
Non-haemodialysis renal patients requiring intravenous iron therapy are increasing the pressure on renal units. A new form of iron therapy can dramatically reduce patient visits, but takes longer to administer. Sunday provision of nurse-led clinics has enabled a switch to this new therapy. Cost savings have more than offset the additional nurse-led sessions and eliminated waiting lists for this group.
