title: A Comparative Look at the Safety Profiles of Intravenous Iron Products Used in the Hemodialysis Population.
abstract: OBJECTIVE
  To review clinical trials conducted in hemodialysis patients of the 4 intravenous iron products available in the US in an attempt to discern strengths and inferiorities between products and evaluate current safety data that can be used to assist the clinician in selecting the most appropriate agent.
  
  
  METHODS
  Literature was accessed through PubMed (January 2000-October 2010). In some cases, reference citations from selected review articles were evaluated as well.
  
  
  METHODS
  Clinical trials published in the English language were selected using the search terms iron dextran, iron sucrose, sodium ferric gluconate, and ferumoxytol. Studies were further pared down to include only those enrolling hemodialysis patients.
  
  
  RESULTS
  There are currently 4 intravenous iron formulations in the US used to treat iron-deficiency anemia in hemodialysis patients. Ferumoxytol has not yet been directly compared to the other 3 agents. Eight studies have been conducted in hemodialysis patients directly comparing iron dextran, iron sucrose, and/or sodium ferric gluconate. These studies were further categorized for evaluation based on iron products compared. Four studies directly compared iron dextran to iron sucrose, 1 study compared iron dextran to sodium ferric gluconate, 1 study compared iron sucrose to sodium ferric gluconate, and 2 studies compared all 3 agents. Of the 3 agents, iron dextran appears to have the least favorable safety profile, while iron sucrose appears most favorable.
  
  
  CONCLUSIONS
  The newest intravenous iron product, ferumoxytol, has not been directly compared to the other 3 agents. Large well-controlled studies of these products specifically in the hemodialysis population would further help clinicians determine appropriate therapy. Iron sucrose appears to offer the most favorable safety profile when compared to iron dextran and sodium ferric gluconate in treating hemodialysis patients. Oxidative stress and hypersensitivity reactions are common problems encountered when administering intravenous iron.
authors.affiliation: Elena Coppol, PharmD Student, College of Pharmacy, Purdue University, West Lafayette, IN.
authors.forename: Elena
authors.initials: E
authors.lastname: Coppol
authors.affiliation: Jamie Shelly, PharmD Student, College of Pharmacy, Purdue University.
authors.forename: Jamie
authors.initials: J
authors.lastname: Shelly
authors.affiliation: Stephanie Cheng, PharmD Student, College of Pharmacy, Purdue University.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Yaman Kaakeh PharmD BCPS BCNSP, Clinical Assistant Professor of Pharmacy Practice, College of Pharmacy, Purdue University.
authors.forename: Yaman
authors.initials: Y
authors.lastname: Kaakeh
authors.affiliation: Brian Shepler PharmD, Clinical Assistant Professor of Pharmacy Practice; Director of Advanced Pharmacy Practice Experiences, College of Pharmacy, Purdue University sheplerb@purdue.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Shepler
mesh_terms: D061605:Administration, Intravenous; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000188:drug therapy; D002986:Clinical Trials as Topic; D005290:Ferric Compounds / Q000627:therapeutic use*; D000077605:Ferric Oxide, Saccharated; D052203:Ferrosoferric Oxide / Q000627:therapeutic use*; D005296:Ferrous Compounds / Q000627:therapeutic use*; D005937:Glucaric Acid / Q000627:therapeutic use*; D006801:Humans; D007505:Iron-Dextran Complex / Q000627:therapeutic use*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy
chemical_list: D005290:Ferric Compounds; D005296:Ferrous Compounds; D007505:Iron-Dextran Complex; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; C011819:ferrous gluconate; D052203:Ferrosoferric Oxide