IV iron dextran alternative to oral iron for anemia in nondialysis CKD

By Sally Robertson, B.Sc.Mar 8 2013

Treatment with intravenous low-molecular-weight iron dextran (LMWID) seems to be an effective alternative for patients with nondialysis chronic kidney disease (ND-CKD) who remain anemic despite receiving oral iron and erythropoiesis-stimulating agents (ESAs).

The findings come from a retrospective chart review of 150 ND-CKD patients enrolled in a computerized anemia management program (CAMP) between 2005 and 2007, who received the LMWID INFeD (n=50) or Nephron FA tablets (n=100) in conjunction with ESAs over a 60-day period.

The program was designed to treat anemia of CKD using a computerized iron-dosing algorithm that prescribed either no iron, oral iron, or 1 g of INFeD over 1.5-2 hours, based on patients' hemoglobin (Hb), iron saturation (TSAT), and ferritin levels.

"IDs [iron dextrans]allow for high-dose infusions, giving it a practical advantage over other IV [intravenous] formulations," explain Lenar Yessayan (Henry Ford Hospital, Detroit, Michigan, USA) and colleagues.

As reported in the International Journal of Nephrology, INFeD significantly improved iron parameters from baseline over the study period.

The LMWID group showed a significant improvement from baseline in mean Hb at days 30 and 60, at 10.7 versus 9.4 g/dL and 11.3 versus 9.4 g/dL, respectively.

In addition, LMWID treatment significantly improved TSAT by days 30 and 60 at 23.4% versus 12.9% and 24.0% versus 12.9%.

A substantial increase from baseline in ferritin was also observed in the LMWID group at day 30, at 359.0 versus 134.7 ng/mL, and levels remained increased at day 60, at 294.0 ng/mL.

To analyse safety outcomes with INFeD use, the team also reviewed data available for any individuals who had received INFeD (n=936) at the hospital between 2001 and 2005. In this cohort, three adverse events occurred, only one of which was categorized as serious. The serious adverse event (AE) rate was one per 1699 total ID infusions and the serious AE rate per 100 mg dose would translate to 12 per 100,000, reports the team.

"Our results support that LMWID when combined with ESA is efficacious in raising Hb and replenishing iron stores in as early as 30 days in ND-CKD patients," say Yessayan and colleagues. "High-dose LMWID should be considered in ND-CKD patients who fail or cannot tolerate oral iron," they add.

The researchers explain: "Since the two groups by protocol design were assigned to different iron and ESA dosing, and dosing was adjusted to reach or maintain a target goal, we did not compare mean differences between the two groups at each evaluation point."

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