Experience with a large dose (500 mg) of intravenous iron dextran and ironsaccharate in peritoneal dialysis patients

. Objective: To compare efficacy in anemia correction and side effects of l arge doses of intravenous (IV) iron dextran and iron saccharate preparation s in peritoneal dialysis (PD) patients. . Setting: Tertiary-care teaching hospital of University of Toronto. . Design: Retrospective analysis of 379 PD patients who attended PD clinics in past 5 years. Of these 379 patients, 62 were selected to receive IV iro n based on ferrokinetic markers of iron deficiency, noncompliance to or ine ffectiveness of oral iron, or increased erythropoietin (EPO) requirement. . Intervention: Sixty-one patients received two IV iron injections of 500 m g each, 1 week apart, 33 patients received iron dextran, 23 received iron s accharate, and 5 received both iron dextran and iron saccharate. One patien t developed anaphylaxis to a test dose of iron dextran and was excluded fro m further therapy. Blood samples were collected before and 3 and 6 months a fter iron infusions. . Results: At 3 months, the group's average hemoglobin rose from 98.3 +/- 1 8.3 g/L to 110.6 +/- 16.4 g/L (p < 0.0001). Ferritin rose from 104.9 +/- 11 5.4 <mu>g/L to 391.5 +/- 294.1 mug/L (p < 0.0001), and transferrin saturati on from 0.17 +/- 0.07 to 0.26 +/- 0.19 (p < 0.0001). Erythropoietin require ments fell from 7278.7 IU/week to 5900 IU/week (p < 0.01). Five of the 34 p atients who received iron dextran developed minor side effects and 1 patien t had anaphylaxis to the test dose. Of the 23 patients who received iron sa ccharate, 1 had an anaphylactic reaction and 2 had transient chest pain, wh ich subsided without therapy. Overall, there were more side effects with ir on dextran (7.4% of injections) compared to the iron saccharate group (4.3% of injections), but this difference was statistically insignificant. Altho ugh statistically insignificant, there was an increase in the number of per itonitis episodes during the 6 months after IV iron infusion, especially wi th iron dextran, compared to the peritonitis episodes during the 6 months b efore iron infusions. . Conclusion: Our study indicates that IV iron in PD patients is effective in restoring iron stores and in decreasing EPO requirements. One anaphylact ic reaction occurred in each group. Our data suggest that as much caution b e exercised with iron saccharate as with iron dextran. The slight trend tow ard increased peritonitis rates after iron infusions needs to be investigat ed in a larger group of patients.