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PubMed2003

[Use of venofer for iron deficiency correction in patients undergoing programmed hemodialysis].

AIM: To study iron metabolism in patients on programmed hemodialysis (PH) in oral and intravenous administration of iron drugs; to compare clinical and financial results of using such drugs. MATERIAL AND METHODS: A two-stage trial studied iron metabolism in 158 PH patients on replacement therapy with erythropoetin. They received correction of iron deficiency with oral drugs (stage I) and venofer (stage II). RESULTS: The study of iron metabolism has found its deficiency in 2/3 patients receiving oral iron: absolute (48%) and relative (20%). Administration of venofer led to a 2-fold increase in the number of patients with normal iron metabolism. The target Hb and Ht were achieved in 2.5 times more patients than before venofer treatment. The dose of erythpoetin in such cases was reduced by 40%. Side effects were not observed. The week cost of venofer treatment per patient was lower by 22.5$ than the cost of treatment with oral iron drugs. CONCLUSION: Venofer correction of iron deficiency in PH patients is more effective both clinically and financially than use of oral iron preparations.

Administration, Oral↗
PubMed2003

Achieving optimal patient outcomes with intravenous iron.

Optimizing i.v. iron management is essential to the overall health of hemodialysis patients. Establishing an i.v. iron protocol, administering a safe and effective i.v. iron supplement, and developing a strong nurse/patient relationship are all indispensable to an effective and efficient hemodialysis program.

Aged↗
PubMed2003

Intravenous iron therapy in chronic kidney disease and peritoneal dialysis patients.

Identical National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) hematologic and iron targets apply to chronic kidney disease (CKD), peritoneal dialysis (PD), and hemodialysis (HD) patients, yet intravenous (i.v.) nondextran iron therapy is FDA approved only in HD patients. This is because oral iron has been considered adequate in CKD and PD patients, and delivering a parenteral therapy on a frequent basis to an outpatient population with notoriously poor vascular access presents logistical complexities. However, recognition of the need for more aggressive treatment of anemia in the CKD and PD population is growing. This awareness, along with the improved safety profiles of the new, nondextran irons, is tipping the risk-benefit ratio toward more widespread use of i.v. iron in these patients. This article provides a summary of the literature and of our own experience using i.v. iron therapy in CKD and PD patients. Our protocol relies on early monitoring and intervention with i.v. ferric gluconate before severe iron deficiency develops. The proactive approach allows for relatively infrequent treatments at only moderately "high" doses (250 mg) of ferric gluconate. The convergence of convenience and safety may expedite more energetic anemia prevention and treatment in PD and CKD patients.

Anemia, Iron-Deficiency↗
PubMedDate not supplied

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. CONCLUSION: 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.

Adolescent↗
PubMed2004

[Comparison of intravenous ascorbic acid versus intravenous iron for functional iron deficiency in hemodialysis patients].

The effect of intravenous ascorbic acid was compared with that of intravenous iron in the treatment of functional iron deficiency, as defined as serum ferritin levels over 300 ng/ml and serum iron levels below 50 microg/dl, in patients on chronic hemodialysis. Thirteen patients on chronic hemodialysis with functional iron deficiency received intravenous injections of ascorbic acid, 100 mg, three times a week, after hemodialysis. The therapy was continued until serum ferritin decreased to below 300 ng/ml (3 months at the maximum). The iron and control group were composed of patients who had serum iron levels below 50 microg/dl within 3 months after serum ferritin rose to over 300 ng/ml. Seven patients with the iron group received more than a total of 10 intravenous injections of saccharated ferric oxide (40 mg/dose) after hemodialysis, and seven patients with the control group received no iron preparation during the 3 months. In the ascorbic acid group, while hemoglobin did not change from 10.9 +/- 0.5 g/dl (mean +/- SE) during the three-month period, serum iron increased significantly from 37 +/- 4 microg/dl to 49 +/- 4 microg/dl after one month (p<0.01), and remained elevated until the end of the three-month period. Serum ferritin decreased significantly from 607 +/- 118 ng/ml to 354 +/- 30 ng/ml after 3 months (p<0.01). In the iron group, hemoglobin and serum iron increased significantly from the respective pre-treatment levels during the 2-month period, and serum ferritin rose significantly after 3 months. In the control group, hemoglobin, serum iron and ferritin levels decreased significantly from the respective pre-treatment levels during the 3 months. The recombinant erythropoietin dose remained stable for three months in the ascorbic acid, iron, and control groups, respectively. These results suggest that in hemodialysis patients with a functional iron deficiency, treatment with intravenous ascorbic acid can prevent iron overload due to treatment with intravenous iron, and provide a useful adjuvant means of maintaining hemoglobin and serum iron levels.

Aged↗
PubMed2004

[How to avoid a haemotransfusion which is not lifesaving? (our experience with administration of intravenous iron to pregnant women and young mothers)].

PURPOSE: To study the effect of intravenous administration of the iron-containing medicine Venofer to pregnant women and young mothers with anaemic syndrome. MATERIAL AND METHODS: A 2-year prospective study was conducted to 50 pregnant women and young mothers, which were treated for iron deficiency anemia in First Obstetrical Clinic of University Hospital - Pleven. There were 27 pregnant women (gestational age 24-39 g. w.) and 23 young mothers. A treatment with Venofer was conducted following 5 ampules regimen of administration--1st day 3 amps and 2d day--2 amps. Venofer is a stabile iron-sucrose complex designed for intravenous application. It is a structural analogue of feritine. Control studies of haemoglobin (Hb) and erythrocytes (Er) were made on 6-7 day after the therapy. RESULTS AND COMMENT: The pregnant women had average starting Hb-data of 90.74 g/l and after the therapy--106.19 g/l. The increase was of 15.74 g/l. Young mothers had Hb-data before the therapy 88.04 g/l and after the therapy 104.5 g/l. The mean increase of Hb was of 16.46 g/l. Undesired side reactions were observed only in one pregnant woman and that necessitated the stop of therapy. Intravenous administration of iron contributed to the good, normal course of pregnancy and fetal growth, and the effect to young mothers consisted of quick and certain recovery of their general state without accomplishing haemotransfusion. CONCLUSION: Therapy with iron-containing medicine gives a good opportunity to avoid the risk of haemotransfusional infections, incopatible haemotransfusions and immunocompromizing effect of allogene haemotransfusion. It is also economically more beneficial.

Anemia, Iron-Deficiency↗
PubMed2005

[Partial least-squares regression analysis for simultaneous spectrophotometric determination of Fe3+ and Al3+].

Adding hexodecyltrimethylammonium bromide(CTMAB) to improve solubility and delicacy, and using chromazurol S as a chromogenic reagent, and acetone as a stabilizing reagent, partial least-squares regression(PLS) was used to determine simultaneously trace amounts of Fe(III) and Al(III) in sythetic samples. Considering the stability of the rays, and the absorption properties of the two ingredients, seven wavelengths between 610 and 670 nm were selected for data collection. As a comparison, the methods of CPA and PLS were used respectively for analysing the data obtained from the experiment, and the results suggested that the latter was much better.

Algorithms↗
PubMed2006

[Postpartum and early postoperative anemia after gynecological surgery: treatment with intravenous iron].

OBJECTIVE: To assess the efficacy and safety of treatment with intravenous iron for postpartum anemia or postoperative anemia after gynecological surgery. PATIENTS AND METHODS: A prospective study enrolling patients entering our recovery care unit from June through December 2004 with hemoglobin levels less than 10 g x dL(-1) after vaginal childbirth or cesarean section or after another form of gynecological surgery. Three 200 mg doses of intravenous iron sucrose (Venofer) were administered on consecutive days. Fifteen days after the last dose, the patient came for follow-up tests and was asked about side effects. The results were analyzed with a Student t test for matched samples. RESULTS: A total of 250 obstetric and 52 gynecological surgery patients were enrolled; 156 and 33 completed the study in each group, respectively. Hemoglobin increased after treatment by 3.2 g x dL(-1) in the obstetric patients and by 2.7 g x dL(-1) in patients who underwent gynecological surgery. The increase was significant in both groups (P<0.001); the 95% confidence interval was 2.918-3.519 for the obstetric patients and 2.220-3.071 for the gynecological surgery patients. The incidence of side effects was low (13 obstetric patients and 1 gynecological surgery patient). Most side effects were related to pain at the injection site (in 12 of the 14 women). CONCLUSIONS: Intravenous iron sucrose is safe and effective for treating puerperal anemia and following gynecological surgery. The low incidence of serious side effects and the rapid recovery of hemoglobin levels make this a safe, effective drug for treating anemia.

Adolescent↗