Total dose iron infusion: Safety and efficacy in predialysis patients

Iron deficiency anemia is not uncommon in predialysis patients. Oral iron o ften cannot maintain adequate iron stores. Hence we evaluated the safety an d efficacy of total dose infusion (TDI) of iron in these patients. Anemic p redialysis patients were screened and those with Hb < 7.0 g/dL and serum fe rritin < 200 ng/mL were selected. Patients with active bleeding and acute l iver disease were excluded. All patients were on oral iron 100 mg/day. None of the patients were on erythropoeitin. 11 patients (6 males and 5 females ), aged 45.9 + 15 yrs. were suitable. Hb was 5.9 +/- 1.0 g/dL and serum fer ritin was 89.5 + 50 ng/mL. The preparation used was iron dextran. A test do se of 25 mg in 100 mL normal saline was administered over 1 hr to all patie nts. One patient had fever and chills during the test dose and was not give n TDI. 10 patients received TDI. None of these patients had any problem dur ing the infusion. The dose of iron administered was 900 + 316.2 mg. One pat ient who received 1600 mg had arthralgia-myalgia and another patient had th rombophlebitis following TDI. One month after TDI, Hb was 8.0 + 1.0 g/dL an d serum ferritin was 362 ng/mL. We feel that TDI is a safe and effective me thod of correcting iron deficiency in predialysis patients.