Intravenous iron supplementation in children on hemodialysis.
BACKGROUND
Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in children with ESRD on HD and the effect on iron status measured.


METHODS
Fourteen patients were divided into three groups according to their actual iron status. Group A--iron deficient (ferritin (F)<100 microg/L, or F 100-400 microg/L and transferrin saturation (TSAT)<20%). These patients were treated with i.v. iron-sucrose 3 mg/kg/dialysis. Group B--iron-replete (F 100-400 microg/L and TSAT> or =20%, or TSAT>50%). These patients received 0.3 mg/kg/dialysis iron-sucrose. Group C--possible iron-overloaded (F>400 microg/L). These patients were not treated with iron.


RESULTS
Group A--3 mg/kg/dialysis of iron-sucrose resulted in a major increase in F, indicating possible iron overload. Therefore, the iron-deficient patients received 1 mg/kg/dialysis iron-sucrose during 22 periods of 2-14 (mean 5) weeks: the median F increased from 186 to 343 microg/L (p<0.001). Group B--0.3 mg/kg/dialysis iron-sucrose resulted in adequate iron levels during 22 periods of 2-60 (mean 9) weeks.


CONCLUSIONS
In children, 3 mg/kg/dialysis iron-sucrose complex results in a possible iron overload. Dosage of 1 mg/kg/dialysis and 0.3 mg/kg/dialysis seem adequate for correction and maintenance therapy respectively.
Leijn
Eveline
E
Department of Pediatric Nephrology, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Monnens
Leo A H
LA
Cornelissen
Elisabeth A M
EA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage*; D000077605:Ferric Oxide, Saccharated; D005293:Ferritins / Q000097:blood; D005937:Glucaric Acid; D006801:Humans; D007275:Injections, Intravenous; D000090463:Iron Deficiencies; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D011994:Recombinant Proteins; D006435:Renal Dialysis; D014168:Transferrin / Q000032:analysis
D005290:Ferric Compounds; D011994:Recombinant Proteins; D014168:Transferrin; D004921:Erythropoietin; D005293:Ferritins; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid