Intravenous Iron Sucrose Administration Research Articles

Effect of intravenous iron on endogenous erythropoietin and FGF-23 secretion in patients with chronic kidney disease

Introduction It has been observed that intravenous iron administration may suppress endogenous production of erythropoietin (EPO). We postulate that this effect may be mediated by increased FGF-23 secretion. Aim of the study To evaluate the short-term effect of intravenous iron sucrose administration on endogenous EPO secretion in patients with chronic kidney disease (CKD). Materials and methods The cohort comprised 35 nondialysis patients with CKD stages 3–5. All received 100 mg of intravenous iron (III)-hydroxide sucrose complex daily for five consecutive days. Plasma EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4), calcium (Ca), and high-sensitive C-reactive protein (CRP) were measured before, and two hours after, the first and third iron infusions, and after completing iron therapy. Results EPO concentration at the end of iron treatment was significantly lower than two hours after the first iron infusion (p = 0.0003) and before the third dose (p = 0.0006) (12.6 [10.2, 41.4] mIU/mL. vs. 30.9 [15.9, 54.2] mIU/mL and 33.4 [15.4, 56.7] mIU/mL, respectively). Conversely, plasma iFGF-23 was significantly higher before the third dose (61.1 [18.6, 420.1 4] pg/mL; p = 0.025) and after the course of treatment (92.1 [28.4, 878.1] pg/mL; p = 0.004) compared to pretreatment value (48.4 [16.2, 420] pg/mL). cFGF-23 concentration was significantly lower than baseline after the first iron dose (491.8 [257.7, 1086.3] vs. 339.2 [75.4, 951.2] RU/mL; p = 0.005) and after treatment (398.7 [90.4, 1022.3] RU/mL; p = 0.025). No significant linear correlation was found between changes in plasma EPO and FGF-23. Conclusions Although intravenous iron therapy causes parallel increase of FGF-23 and supression of endogenous EPO, these two effects seem to be independent.

Associations of Iron Sucrose and Intradialytic Blood Pressure

Intradialytic hypotension and intradialytic hypertension are associated with morbidity and mortality in hemodialysis (HD). Many factors can contribute to intra-HD blood pressure (BP) changes, such as drugs with vasoactive properties that can destabilize an already tenuous BP. Intravenous iron sucrose is commonly administered to correct iron deficiency; however, its reported associations with altered hemodynamics have not been consistent. Prospective cohort study. 950 outpatients receiving maintenance HD. Iron sucrose administered during HD. Intradialytic hypotension, intradialytic hypertension, systolic blood pressure parameters. Unadjusted and adjusted Poisson and linear repeated measures regression models. The mean age of patients included in the study was 53±22 years, 43% were female, and 38% were Black. Mean pre-HD SBP was 152±26 (SD) mm Hg. At baseline, the patients who received higher doses of iron sucrose tended to have diabetes, have longer HD sessions, and have a higher frequency of erythropoiesis-stimulating agent use, compared with those who did not receive iron sucrose. In adjusted models, higher doses of iron sucrose were associated with an 11% lower rate of intradialytic hypotension (incidence rate ratio [IRR] for iron sucrose≥100mg vs 0 mg, 0.89 [95% CI, 0.85-0.94]). In adjusted analyses, the administration of higher doses of iron sucrose during HD was associated with intradialytic hypertension (IRR for iron sucrose≥100mg vs 0 mg, 1.07 [95% CI, 1.04-1.10]). Nonavailability of the precise iron sucrose formulation (volume), laboratory data for each HD session, and outpatient medications. Objective measures of volume status, home medications, and symptom data were not recorded in this study. We observed an independent association of intravenous iron sucrose administration during HD with a lower risk of intradialytic hypotension and higher risk of intradialytic hypertension. Future studies to better understand the mechanisms underlying these associations are warranted. Intradialytic hypotension and intradialytic hypertension are common among patients on hemodialysis, and they are associated with morbidity and mortality. Although many factors may contribute to these risks, medications administered during hemodialysis play an important role. We studied the significance of the intravenous iron sucrose used to treat iron deficiency and the impact it may have on blood pressure during dialysis. In our study of 950 outpatient hemodialysis patients, we observed that administration of iron sucrose was associated with higher systolic blood pressure (during and after hemodialysis sessions) as well as a lower risk of intradialytic hypotension. We also observed that higher doses of iron sucrose are associated with the development of intradialytic hypertension.

A COMPARATIVE STUDY OF INTRAVENOUS IRON SUCROSE VERSUS ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA DURING POSTPARTUM PERIOD

Introduction: Anemia is the commonest major contributing factor in maternal mortality and morbidity in developing countries and according to World Health Organization (WHO) criteria, it contributes to 20% of maternal deaths. Anemia in pregnancy defined as hemoglobin level <11 gm/dl (7.45 mmol/L) and hematocrit less than 33% (WHO).
 Aim: To compare the efficacy of oral iron ferrous sulphate therapy with intravenous iron sucrose therapy in the treatment of iron deficiency anemia during postpartum period.
 Material & Methods: This was a prospective randomized comparative clinical trial single center study conducted on 200 postpartum women aged >18 years (after normal delivery or LSCS) within 10 days of delivery with Hb level more or equal to 6 gm/dl but less than 10 gm/dl were included in the study. This was a one year study conducted during 1st December 2018 to 30th November 2019.
 Results : There was a significant increase in the hemoglobin level in both the groups i.e. in IV iron group, from 8.26 ±1.03gm/dl on day 1 to 11.62±0.94gm/dl on day 45 as compared to oral iron group, from 8.24±1.09gm/dl on day 1 to 11.07±1.14gm/dl on day 45; and serum ferritin level from 41.69±40.45ng/ml on day 1 to 77.34±41.60ng/ml on day 45 in IV iron group as compared to the oral iron group from 22.20±8.82ng/ml on day 1 to 31.72±9.72 ng/ml on day 45. So, there was a rapid increase in both hemoglobin and serum ferritin levels in IV iron group as compared to the oral iron group.
 Conclusion: Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin more rapidly in compare to the oral intake of ferrous sulphate in women with iron deficiency anemia in postpartum women in our study.
 Keywords: Iron deficiency anemia, Intravenous iron sucrose, Serum ferritin, Maternal mortality.

Phlebitis After Intravenous Iron Sucrose Administration in Postpartum Women.

Phlebitis After Intravenous Iron Sucrose Administration in Postpartum Women.

P0860INTRAVENOUS IRON ADMINISTRATION SUPPRESSES ENDOGENOUS ERYTHROPOIETIN SECRETION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Iron therapy may induce inflammatory response that may indirectly affect endogenous erythropoietin (EPO) production. We postulated that increased secretion of FGF-23 may provide a link between intravenous iron administration and suppression of endogenous EPO secretion. Evaluation of a short-term effect of intravenous iron sucrose administration on the secretion of endogenous EPO in patients with chronic kidney disease (CKD). Method 35 non-dialysed patients with G3b-5 CKD were included. All patients received 100 mg of intravenous iron infusion (iron (III)-hydroxide sucrose complex) daily for 5 days. Plasma concentration of EPO, iFGF-23, cFGF-23, PTH, bone alkaline phosphatase (BAP), phosphorus (PO4) and calcium (Ca) were measured before and two hours after the first and third iron infusion and at the end of iron therapy. Results EPO concentration at the end of iron treatment was significantly lower compared to 2 h after the first iron infusion (p<0.001) and before the third dose (p<0.001) (12.6 [31.2] mIU/mL, 30.9 [38.3] mIU/mL, 33.4 [41.3] mIU/mL and, respectively). Conversely, serum iFGF-23 increased significantly after the third dose (61.1 [401.5] pg/mL; p<0.05) and after the treatment (92.1 [849.7] pg/mL; p<0.01) compared to pre-treatment value (48.4 [403.8] pg/mL). cFGF-23 concentration decreased significantly after the first dose of iron (491.8 [828.6] vs. 339.2 [875.8] RU/mL; p<0.01) and after the completion of the therapy (398.7 [931.9]) vs. baseline (p<0.05). There was no linear correlation between EPO and FGF-23. Conclusion Intravenous iron therapy increases the secretion of FGF-23 and supresses endogenous EPO production but these two effects do not seem to be related.

Intravenous Iron sucrose and change in hemoglobin, ferritin, and oxidative stress markers among moderately anemic pregnant women attending a secondary care level Hospital in Northern India.

Intravenous iron is associated with oxidative stress, and very few studies have assessed change in oxidative stress markers post infusion. The study aimed to measure the change in levels of hemoglobin (Hb), serum ferritin, and select oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD], and ferric reducing ability of plasma [FRAP]) 4 weeks following the administration of intravenous iron sucrose (IVIS) among moderately anemic pregnant women who were attending a secondary-level health-care facility, Haryana, North India. An observational study was conducted (May 2016 to Jan 2018) among pregnant women receiving intravenous iron sucrose i.e., IVIS (300 mg per dose) diluted in 300 mL of normal saline over 20-45 min and were followed up for a period of 4 weeks after the last dose of IVIS (end line). The study outcomes were measured in the levels of Hb, serum ferritin, MDA, SOD, and FRAP from the baseline to the end line. The mean (95% confidence interval) change in the Hb and serum ferritin level 4 weeks after the last dose of IVIS was an increase of 2.5 (2.1-3.0) g/dL (P < 0.001) and 63.0 (44.7-81.3) ng/mL (P < 0.001), respectively. There were no significant changes (baseline to end line) in mean (standard deviation [SD]) MDA level and mean (SD) FRAP level. The mean (SD) SOD level declined significantly (2.2 [0.4] U/mL to 1.6 [0.5] U/mL [P < 0.001]). No life-threatening adverse events were encountered during the study. IVIS was well tolerated and effective in treating moderate anemia in pregnancy. Body iron store was replenished following IVIS administration. There was no increase in oxidative stress following IVIS therapy.

Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural Northern India.

Introduction:To combat anemia among pregnant women, in Haryana, Northern India, administration of intravenous iron sucrose (IVIS) was initiated in 2014 as a public-health measure. We assessed the effect of IVIS on hemoglobin (Hb) levels among the pregnant anemic women.Methods:Pregnant women identified as moderately or severely anemic (Hb <10.0 g/dL) in the second or third trimester during routine antenatal care were prescribed IVIS in a standard-dose of 400 mg given as 100 mg on alternate days. Neither dose calculation, nor allowance for iron-store, was included in this study. We analyzed the data collected between June 2014 and December 2015, at the two primary-health-centers, on Hb level (by HemoCue method) before start of the therapy (baseline), and 4-week or more after the last infusion (endline).Results:A total of 990 women received IVIS. Both baseline and endline Hg-levels were available for 763 (77%), who were included in the analysis. At baseline, the proportion of moderate and severe anemia was 87.94% and 12.06%, respectively. Mean (standard deviation)-Hb increased from 7.85 g/dL (0.80) at baseline, to 9.62 g/dL (1.30) at endline, with a mean increase of 1.76 g/dL (95% confidence interval 1.67, 1.85). The mean increase in Hb-level for pregnant women who had severe and moderate anemia at baseline was 2.54 g/dL and 1.65 g/dL, respectively. Overall, 15.33% of women achieved normal Hb-level by the time of endline measurement. No serious adverse reactions were reported during the observation period.Conclusion:Mean increase in Hb-level was 1.76 mg/dL. Severely anemic pregnant women had larger increase in Hb-level when compared with pregnant women with moderate anemia.

Study of Increase in Hemoglobin Concentration after Administration of Intravenous Iron Sucrose in Pregnant Women with Severe Anemia

Study of Increase in Hemoglobin Concentration after Administration of Intravenous Iron Sucrose in Pregnant Women with Severe Anemia

Correction of preoperative anemia in women with menorrhagia: IV iron sucrose versus oral iron

Objective: To compare the safety and efficacy of iron sucrose over oral iron for the correction of preoperative anemia in women with menorrhagia. Methods: Women with menorrhagia having Hemoglobin (Hb) level less than 10 gm/dl and features of iron deficiency were included in the study. Women matching the inclusion and exclusion criteria, allocated to group A (IV iron sucrose) or group B (oral iron). IV iron sucrose was administered as 100 mg (2 ampoules) in 100 ml normal saline by slow IV infusion. The women in the group B received ferrous sulphate as oral iron in the dose of one tablet (200 mg salt) three times a day. Repeat laboratory estimations were done after four weeks. Results were analyzed by paired t test using SPSS 15 and Microsoft excel. Results: Before treatment, mean Hemoglobin level (mean ± SD) was similar in both groups (7.18 ± 1.18 gm/dl in group A and 7.18 ± 1.02 gm/dl in group B). After treatment, rise of Hb level was more in group A (10.70 ± 0.73 gm/dl) than group B (9.64 ± 0.70 gm/dl). After treatment, the desired Hb level of 10 gm/dl or more were achieved in 96% of women in group A while only in 56% of women in group B. Conclusion: Preoperative intravenous iron sucrose administration is more effective than oral iron and is as safe as oral iron therapy in the correction of preoperative anemia due to menorrhagia.

Intravenous iron sucrose for restless legs syndrome in pregnant women with low serum ferritin

We report on two pregnant women who either had de novo restless legs syndrome (RLS) or had marked enhancement of preexisting RLS symptoms during pregnancy. Both patients had ferritin values <50μg/L at baseline. The patients had relevant sleep disorders and daytime symptoms caused by RLS. The women were treated in an open paradigm with intravenous iron sucrose. A few weeks after therapy, both patients experienced a significant reduction or even remission of RLS symptoms. Their quality of life and sleep substantially improved and no treatment-related adverse effects were observed. According to our initial experience, intravenous iron sucrose administration appears to be an effective therapy in RLS patients with low ferritin values during pregnancy.

Hierro intravenoso preoperatorio como estrategia de ahorro de sangre en cirugía de fractura de cadera

Background and objectiveTo determine whether administration of intravenous iron in a patient diagnosed with hip fracture reduces the need for blood transfusion. Patients and methodsA retrospective observational case-control study was performed comparing a control group of 63 patients diagnosed with hip fracture with another group of 57 patients treated with parenteral iron. Demographic, clinical condition/clinical record and hematometric differences of the case-control patients were described. We analyzed the morbidity (post-surgical infection) and mortality rate. SPSS® was used for statistical studies. ResultsBeing statistically significant, after the administration of intravenous iron sucrose, the need of blood transfusion was reduced in the case group, as well as the quantity of concentrates required (1.37 vs 0.6). In the case group, there was a statistically significant decreasing trend in hospital mortality rate (case group: 0.8%/control group: 8.3%). It was not been proven the relation between the decrease in nosocomial infection and the administration of intravenous iron ConclusionsThe administration of intravenous iron sucrose in patients diagnosed with hip fracture before surgery could be effective blood saving measure in this type of trauma surgery. Furthermore, its use has been reliable without causing any side effects.

COMPARATIVE STUDY OF INTRAVENOUS IRON SUCROSE VERSUS ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA DURING POSTPARTUM PERIOD

Background:- Iron deficiency is the principle cause for nutritional anemia. The aim of the study was to compare the efficacy of oral iron therapy with intravenous iron therapy in the treatment of iron deficiency anemia during postpartum period Material and Methods:- A clinical observational studY. Results :- .On day 5 of the  intravenous iron group , there was statistically significant increase in serum ferritin level from 11.47 + 1.655 µg/l to 41.44 + 6.500 µg/l (p value <0.01), and the ferritin level remained elevated on day 14 and day 40. There was significant increase in mean  Hb level from 7.76 + 0.7137 g/dl  to 10.78 + 0.7679 g/dl on day 40 (p value < 0.01) in oral iron group. There was increase in mean Hb level from7.47 + 0.7678 g/dl  to 11.41 + 0.7908 g/dl on day 40 in injectable iron group ,which was  statistically significant. (p value < 0.01) Intravenous iron sucrose did not result in any serious adverse reactions. Conclusion:- Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin levels more rapidly ,without any serious adverse effect in comparison with oral ferrous sulphate in women with iron deficiency anemia in the postnatal period .

O228 Rapid versus slow intravenous iron sucrose administration in pregnant women with iron deficiency anemia in a rural setting in India

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S158-S158 Free communication (oral) presentations O228 Rapid versus slow intravenous iron sucrose administration in pregnant women with iron deficiency anemia in a rural setting in India H. Divakar, Search for more papers by this authorN. Kumar, Search for more papers by this authorI. Manyonda, Search for more papers by this author H. Divakar, Search for more papers by this authorN. Kumar, Search for more papers by this authorI. Manyonda, Search for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60600-7Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S158-S158 RelatedInformation

Efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in patients undergoing surgery for hip fracture repair. An observational cohort study

Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl. The blood conservation protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl) and the perioperative administration of intravenous iron sucrose (3 x 200 mg/48 h) (group 1, n = 115). Additionally, some patients received preoperative rHuEPO (40 000 IU sc) on admission to the orthopaedic ward (group 2, n = 81). Overall, 103 of 196 patients (52.5%) received at least one ABT unit (2.1 +/- 1.0 U/patient). However, there were significant differences in perioperative ABT rates between groups (60% vs. 42%, for groups 1 and 2, respectively; P = 0.013). Postoperative Hb on postoperative days 7 and 30 was higher in group 2 than in group 1. In addition, in group 2, Hb levels were higher on postoperative day 30 than on admission (12.7 +/- 1.0 g/dl vs. 11.9 +/- 0.8 g/dl, respectively; P = 0.030). Administration of rHuEPO did not increase postoperative complications or 30-day mortality rate. Only three mild intravenous iron adverse effects were witnessed. In anaemic hip fracture patients managed with perioperative intravenous iron and restrictive transfusion protocol, preoperative administration of rHuEPO is associated with reduced ABT requirements. However, appropriate training, education and awareness are needed to avoid protocol violations and to limit further exposure to ABT and ABT-related risks.

Safety and Usefulness of Intravenous Iron Sucrose in the Management of Preoperative Anemia in Patients with Menorrhagia: A Phase IV, Open-Label, Prospective, Randomized Study

Background: The aim of this study was to compare the efficacy, safety and achievement of the target hemoglobin level (Hb ≥10 g/dl) in patients with preoperative anemia due to menorrhagia who received intravenous iron sucrose compared with oral iron protein succinylate for anemia management. Methods: Seventy-six patients with Hb levels <9.0 g/dl who were scheduled to undergo surgical treatment were randomized to receive either intravenous iron sucrose (based on the calculated total iron deficit divided into 2 ampoule infusions intravenously 3 times a week, beginning 3 weeks before surgery) or oral iron (80 mg/day of oral iron protein succinylate daily). Results: The intravenous iron group had higher increases in Hb (3.0 vs. 0.8 g/dl; p < 0.0001) and ferritin levels (170.1 vs. 4.1 μg/l; p < 0.0001) than the oral iron group. Achieving the target Hb was also higher in the intravenous iron group than in the oral iron group (76.7 vs. 11.5%; p < 0.0001). There were tolerable adverse events in both groups. Conclusion: Preoperative intravenous iron sucrose administration is more effective than oral iron and is as safe as oral iron therapy in the correction of preoperative anemia due to menorrhagia.

Efficacy of Intravenous Iron Sucrose Administration for Correcting Preoperative Anemia in Patients Scheduled for Major Orthopedic Surgery

We thank Dr. Cuenca et al. for their comments on our article about the efficacy of intravenous iron sucrose in the treatment of preoperative anemia in patients undergoing major orthopedic surgery,1and are glad to answer their comments.We used the World Health Organization definition for anemia as inclusion criteria for our study and reviewed the literature concerning iron deficiency anemia. Interestingly, there is not one universally applicable definition for iron deficiency anemia. Recent papers by Thomas et al. 2–4indicate that the traditional definition for iron deficiency anemia with mean corpuscular volume &lt; 80 fl or a ferritin level &lt; 15–30 μg/l or transferrin saturation &lt; 15% does not take into account the effect of a possible inflammatory state. Therefore, we measured C-reactive protein as well as leukocyte count for every patient at the moment of inclusion. Leukocyte counts ranged from 4,300 to 9,500/μl (reference values being 4,000–10,000/μl in our laboratory) and C-reactive protein ranged from 0 to 12 mg/l (reference, &lt; 7 mg/l). By measuring the soluble transferrin receptor and calculating the ferritin index (soluble transferrin receptor/log ferritin ratio), and using different cutoff values depending on the measured C-reactive protein, we were able to select iron deficiency anemia.The theoretical total iron deficit for a target hemoglobin of 15 g/dl was calculated for every patient. Total iron deficit was 1,088 ± 239 mg, indicating that the administered dose of 900 mg was indeed slightly less than theoretically needed. Therefore, higher doses may be used in future studies. The perioperative blood loss was not considered in the calculation of the total iron dose, because only the preoperative hemoglobin increase was assessed.We compared the transfusion outcome of our group of patients with the study of Cuenca et al. 5and found astonishing similarities in both groups treated with intravenous iron. Comparing our results with a combined erythropoietin and intravenous iron treatment6or a treatment with oral iron7appears inadequate.8The question on repeated low dose intravenous iron was assessed in patients on hemodialysis.9Schiesser et al. 9showed that it is possible to maintain the iron status and the hemoglobin level with low dose intravenous iron. However, such a regimen did not allow improving the hemoglobin level. Nevertheless, in orthopedic surgery a direct comparison between repeated low dose versus high dose intravenous iron regimen may be the subject of a future study.In conclusion, intravenous iron should be considered for the relative rapid correction of iron deficiency anemia. However, the real benefit of such a regimen in the context of (orthopedic) surgery needs to be proven in a future prospective, randomized, placebo-controlled trial.*University Hospital and University of Zurich, Zurich, Switzerland. oliver.theusinger@usz.ch

Efficacy of Intravenous Iron Sucrose Administration for Correcting Preoperative Anemia in Patients Scheduled for Major Orthopedic Surgery

To the Editor:—Preoperative anemia is a common condition among surgical patients, and it is an independent risk factor for blood transfusion in major surgery with moderate to high blood loss. Consequently, the first step to be taken in the setting of elective surgery will be the preoperative identification and evaluation of anemia early enough to implement the appropriate treatment. In this regard, we read with interest the report by Theusinger et al. 1 about the use of intravenous iron sucrose for the treatment of iron deficiency anemia in orthopedic surgical patients. They found a mean maximum increase in hemoglobin (1.0 0.6 g/dl) 2 weeks after the start of intravenous iron treatment, indicating that administration of intravenous iron 2–3 weeks before surgery may be optimal. We would like to comment regarding the patients’ inclusion criteria, the dosage and administration schedule of iron sucrose, and the comparison of their data with those of the study by Cuenca et al. 2 in patients sustaining a pertrochanteric hip fracture. First, although Theusinger et al. 1 clearly defined anemia according to World Health Organization criteria as hemoglobin level 12 g/dl for women and hemoglobin 13 g/dl for men, their definition of iron deficiency was complex and somehow arbitrary. According to other authors, iron deficiency anemia is defined by anemia with mean corpuscular volume 80 fl, ferritin level 15–30 g/l, and transferrin saturation 15%. 1 On the other hand, in the event of inflammation (C-reactive protein 5 mg/l), iron deficiency may be defined as transferrin saturation 20% and ferritin 50 –100 g/l. 3 Therefore, the cutoff values used in this paper (ferritin 100 mg/l or 100 –300 g/l with transferrin saturation 20%) are compatible not only with iron deficiency anemia but also with anemia of chronic disease, with or without true iron deficiency. 3,4 Thus, it is conceivable that a mixed anemic patient population was included in this study. This may be important, because the endogenous erythropoietin response to low hemoglobin is more substantial in iron deficiency anemia than in anemia of chronic disease, and erythropoietin increases the mobilization and incorporation of iron into the erythron. 3 Inflammatory mediators involved in anemia of chronic disease also impair duodenal iron absorption and iron mobilization from body stores. 4

Peritoneal effects of intravenous iron sucrose administration in rats

Intravenous iron supplementation is commonly used in uremic patients treated with peritoneal dialysis. Infusion of iron compounds results in various systemic noxious effects, mainly because of its prooxidant and proinflammatory actions. The authors studied how the intravenous infusion of iron sucrose (IS) affects intraperitoneal homeostasis in rats undergoing acute peritoneal dialysis. Experiments were performed on Wistar rats, which were infused intravenously with IS in a dose 10 mg/kg body weight or with normal saline in the controls. Simultaneously, 4-hour acute peritoneal dialysis was started. At the end of the dialysis, systemic and peritoneal inflammatory reaction and peritoneal permeability were evaluated. Compared with controls, rats exposed to IS showed increased dialysate iron concentration by +70%, P<0.001, and in the differential cell count, more eosinophils (+113%, P<0.05) and fewer macrophages (-16%, P<0.05) existed. In in vitro conditions, macrophages obtained from IS-treated rats released more tumor necrosis factor-alpha (TNF-alpha; +173%, P<0.05) upon stimulation with endotoxin. Additionally increased (+73%, P<0.01) dialysate elastase activity was found in IS-treated animals. Rats infused with IS demonstrated increased peritoneal permeability to total protein (+60%, P<0.001) as compared with control animals. When rats with simultaneous peritonitis received intravenous IS, ex vivo isolated peritoneal leukocytes generated more free radicals (+73%, P<0.05) than did cells harvested from control animals. It has been concluded that intravenous infusion of IS affects the intraperitoneal homeostasis in rats, moving it toward the inflammatory state. These changes may contribute to peritoneal damage.

Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients

Haemodialysis patients need sustained treatment with intravenous iron because iron deficiency limits the efficacy of recombinant human epoetin therapy in these patients. However, the optimal intravenous iron maintenance dose has not been established yet. We performed a prospective multicentre clinical trial in iron-replete haemodialysis patients to evaluate the efficacy of weekly low-dose (50 mg) intravenous iron sucrose administration for 6 months to maintain the iron status, and to examine the effect on epoetin dosage needed to maintain stable haemoglobin values in these patients. Fifty patients were enrolled in this prospective, open-label, single arm, phase IV study. Forty-two patients (84%) completed the study. After 6 months of intravenous iron sucrose treatment, the mean ferritin value showed a tendency to increase slightly from 405 +/- 159 at baseline to 490 +/- 275 microg/l at the end of the study, but iron, transferrin levels and transferrin saturation did not change. The haemoglobin level remained stable (12 +/- 1.1 at baseline and 12.1 +/- 1.5 g/dl at the end of the study). The mean dose of darbepoetin alfa could be reduced from 0.75 to 0.46 microg/kg/week; epoetin alfa was decreased from 101 to 74 IU/kg/week; and the mean dose of epoetin beta could be reduced from 148 to 131 IU/kg/week at the end of treatment. A regular 50 mg weekly dosing schedule of iron sucrose maintains stable iron stores and haemoglobin levels in haemodialysed patients and allows considerable dose reductions for epoetins. Low-dose intravenous iron therapy may represent an optimal approach to treat the continuous loss of iron in dialysis patients.

Administration of Intravenous Iron Sucrose as a 2-Minute Push to CKD Patients: A Prospective Evaluation of 2,297 Injections

Intravenous iron supplementation is an integral part of the management of anemia in patients with chronic kidney disease. Traditionally, this has been administered as an infusion over 1 or more hours, which requires the use of intravenous fluids and administration tubing, along with extra demands on patient and nursing time. We prospectively investigated the safety and practicality of administering iron sucrose, 200 mg, as a bolus injection over 2 minutes in patients with chronic kidney disease. A total of 2,297 injections were administered to 657 patients. Any adverse events were recorded, including acute anaphylactoid reactions to the iron injection, along with the presence or absence of metallic taste and phlebitis, and these were classified as "serious" and "nonserious." The most common adverse event was a mild and transient metallic taste that occurred during 412 injections (17.9%); in no case was this of significant distress to the patient. Excluding this, 2,240 injections (97.5%) proceeded uneventfully, and no case of phlebitis was recorded. Adverse events other than metallic taste were recorded in association with 57 injections (2.5%). Seven of these were caused by an acute anaphylactoid reaction to the intravenous iron. All 7 acute reactions resolved completely within 30 minutes with no sequelae, and none required hospitalization. The remaining 50 adverse events consisted of pain during the injection (n = 31), pain after the injection with or without some bruising (n = 9), nausea/gastrointestinal symptoms (n = 3), lethargy (n = 4), and lightheadedness (n = 3). Administration of 200 mg of iron sucrose as an intravenous bolus injection over 2 minutes is a practical dosing regimen in patients with chronic kidney disease, resulting in considerable savings in time and cost.