Experience with the use of an iron polymaltose (dextrin) complex given by single total dose infusion to stable chronic haemodialysis patients.
BACKGROUND
Many studies of anaemia in patients on chronic haemodialysis have noted a high prevalence of iron deficiency despite oral iron supplementation. Our study examined the effect of intravenous iron given as bolus replacement. As the majority of these patients were not receiving concurrent recombinant human erythropoietin (rhEPO) it allowed an analysis of the safety and efficacy of intravenous iron as a single agent.


METHODS
All patients with a haemoglobin level of less than 10 g/dl and considered iron deficient by the finding of a percentage transferrin saturation of less than 20% were given intravenous iron in the form of iron polymaltose (dextrin) by total dose infusion (TDI). The dose was calculated from tables supplied by the manufacturers. Patients with serum ferritin levels in excess of 225 ng/ml were excluded.


RESULTS
In our unit, 62 out of 80 (77%) patients were considered iron deficient and received IV iron. Ten (10%) were considered to be in iron balance and 8 (10%) had biochemistry suggesting iron overload. None of the patients receiving iron experienced any adverse reactions. At three months a rise in haemoglobin level of at least 1 g/dl was noted in 53% of patients. The response was less in the remainder, but only 2 showed no response.


CONCLUSIONS
Low levels of iron deficiency are often unrecognized in chronic haemodialysis patients on conventional therapy including oral iron supplementation. In such patients, the use of total dose infusion of iron polymaltose (dextrin) is a safe and effective method of raising haemoglobin levels. Substantial improvements may be achieved without the concurrent use of rhEPO.
van Zyl-Smit
Roal
R
Department of Medicine, Renal Unit E13, Groote Schuur Hospital, University of Cape Town, Observatory 7935, South Africa. vzsmit@curie.uct.ac.za
Halkett
Janet A
JA
D000328:Adult; D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D003912:Dextrins / Q000008:administration & dosage*; D004909:Erythrocyte Indices / Q000187:drug effects; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D007501:Iron / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008320:Maltose / Q000008:administration & dosage*; D008875:Middle Aged; D006435:Renal Dialysis; D014168:Transferrin / Q000378:metabolism
D003912:Dextrins; D006454:Hemoglobins; D014168:Transferrin; D008320:Maltose; C049580:dextrin maltose; D005293:Ferritins; D007501:Iron