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Clinical update: intravenous iron for anaemia

2007; Elsevier BV; Volume: 369; Issue: 9572 Linguagem: Inglês

10.1016/s0140-6736(07)60689-8

1474-547X

Michael Auerbach, Harold S. Ballard, John A. Glaspy,

Erythropoietin and Anemia Treatment

For nearly half a century, parenteral iron has been considered dangerous and for use only in extreme situations and when oral iron was not tolerated. This proscription was based largely on poorly characterised and infrequent anaphylactoid reactions to the high-molecular-weight dextran preparation (Imferon) that for most of this time was the only product available. Moreover, when parenteral iron was necessary, the recommended approach was small intramuscular doses (≤100 mg), even after intravenous administration of the total iron deficit as a single dose or as repetitive boluses was shown to be as safe and effective as the intramuscular route. 1 Kanakaraddi VP Hoskatti CG Nadig VS Patil CK Maiya M Comparative therapeutic study of TDI and IM injections of iron dextran complex in anaemia. J Assoc Physicians India. 1973; 21: 849-853 PubMed Google Scholar , 2 Hamstra RD Block MH Schocket AL Intravenous iron dextran in clinical medicine. JAMA. 1980; 243: 1726-1731 Crossref PubMed Scopus (250) Google Scholar , 3 Auerbach M Witt D Toler W Fierstein M Lerner RG Ballard H Clinical use of the total dose intravenous infusion of iron dextran. J Lab Clin Med. 1988; 111: 566-570 PubMed Google Scholar , 4 Auerbach M Winchester J Wahab A et al. A randomized trial of three iron dextran infusion methods for anemia in EPO-treated dialysis patients. Am J Kidney Dis. 1998; 31: 81-86 Summary Full Text Full Text PDF PubMed Scopus (67) Google Scholar This mindset persists despite the subsequent introduction of low-molecular-weight iron dextran and two iron salt preparations, ferric gluconate and iron saccharate (the latter is also known as iron sucrose), all of which are associated with fewer serious adverse events than the high-molecular-weight dextran. The introduction of recombinant erythropoietin for dialysis patients was associated with the development, in some individuals, of functional iron deficiency that limited efficacy. Intravenous iron, unlike oral iron, improves erythropoietic response in dialysis patients, 5 Fishbane S Ungureanu VD Maesaka JK Kaupke CJ Lim V Wish J The safety of intravenous iron dextran in hemodialysis patients. Am J Kidney Dis. 1996; 28: 529-534 Summary Full Text PDF PubMed Scopus (235) Google Scholar , 6 Fishbane S Mittal SK Maesaka JK Beneficial effects of iron therapy in renal failure patients on hemodialysis. Kidney Int. 1999; 55: S67-S70 Summary Full Text Full Text PDF Google Scholar and is now routinely used. 7 Adamson JW Eschbach JW Erythropoietin for end-stage renal disease. N Engl J Med. 1998; 339: 625-627 Crossref PubMed Scopus (52) Google Scholar