Administration of intravenous iron sucrose as a 2-minute push to CKD patients: a prospective evaluation of 2,297 injections.
BACKGROUND
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.


METHODS
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."


RESULTS
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).


CONCLUSIONS
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.
Macdougall
Iain C
IC
Department of Renal Medicine, King's College Hospital, London, UK. iain.macdougall@kingsch.nhs.uk
Roche
Alison
A
D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000209:etiology; D000747:Anemia, Hypochromic / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D015331:Cohort Studies; D004408:Dysgeusia / Q000139:chemically induced; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; D006084:Graft Rejection; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007275:Injections, Intravenous; D007674:Kidney Diseases / Q000150:complications* / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011446:Prospective Studies
D005290:Ferric Compounds; D004921:Erythropoietin; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid