Dr. Neville R. Dossabhoy and Dr. Sarah Khan

Dr. Sarah Khan (SK), senior Nephrology Fellow, and Dr. Neville R. Dossabhoy (ND), Chief of Nephrology Section, from LSUHSC-Shreveport and VA Medical Center discuss their abstract for the National Kidney Foundation’s 2014 Spring Clinical Meetings (SCM14), Head-To-Head Comparison of Safety Profiles of Various Intravenous Iron Agents in CKD Patients, with Dr. Kenar Jhaveri (eAJKD), eAJKD Editor.

eAJKD: Why don’t you tell us a little about your research and abstract being presented at NKF 2014 Spring Meetings?

SK&ND:  There are multiple intravenous (IV) iron formulations available on the market today, but very few studies have made a head-to-head comparison of these products. We have previously presented data on the safety and efficacy of total dose iron dextran in CKD patients. We recently published a paper entitled “Intravenous Iron Repletion Does Not Significantly Decrease Platelet Counts in CKD Patients with Iron Deficiency Anemia,” which was initially presented as an abstract at the NKF 2011 Spring Meetings.

The purpose of this pilot study is to directly compare the safety profiles of various IV iron formulations in patients with chronic kidney disease (CKD) and iron deficiency anemia (IDA). This is a retrospective chart review of patients receiving various IV iron formulations at a single center, the VA Medical Center, Shreveport, LA. We included all patients with IDA and CKD stages 3 and higher, who were treated with parental iron at our hospital over the study period. K-DOQI guidelines and prevailing clinical practice determined the need and usage of IV iron in these CKD patients. Data collected included patient demographics and co-morbidities, baseline renal and hematological parameters, and adverse events noted with drug administration. Iron sucrose (IS) and ferric gluconate (FG) were given in doses used routinely in clinical practice; whereas iron dextran (ID) at our center was given as a total dose infusion (TDI) of 1000 mg administered IV over 4-6 hours (if no reaction was noted to an initial test dose).

This pilot study examined the records of patients administered 609 doses of IV iron. Their demographics and baseline lab values are mentioned in the abstract. Adverse events (AE) were noted in 8 out of 261 administered doses (3.1%) with total dose infusion of iron dextran – the commonest being itching, chills and back pain. No AE was noted with either iron sucrose or ferric gluconate. No anaphylactic reaction was noted with any product.

We concluded that iron dextran given as a total dose infusion has a higher rate of AE’s than routine doses of IS or FG (P < 0.05 by chi-square test). However, all of the AE’s were minor, and none were life-threatening.

eAJKD: Why do you think iron dextran had the most adverse events compared to the other formulations?

SK&ND:  This may be explained by the much higher dose used for TDI iron dextran, as compared to the other two. The average doses administered in our study for IS, FG and ID were 334 mg, 124 mg and 1000 mg, respectively. Alternatively, this finding may be an effect of the relatively small sample size.

eAJKD: Where do you and your group go from here?

SK&ND:  As a direct corollary from #2 above, our group intends to expand this pilot study, and include a larger number of patients in each of the study groups by extending the study period. We would also like to include other, newer, IV iron formulations in our future studies.

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