Is Absorption of High-Dose Oral Iron Sufficient in Peritoneal Dialysis Patients?

2000 ◽  
Vol 20 (6) ◽  
pp. 667-673 ◽  
Author(s):  
Elisabeth Dittrich ◽  
Heidi Puttinger ◽  
Barbara Schneider ◽  
Walter H. Hörl ◽  
Marianne Haag–Weber ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Deficiency ◽  
Iron Absorption ◽  
Oral Iron ◽  
Iron Sulfate ◽  
High Dose ◽  
Absorption Test ◽  
Control Subjects ◽  
Dose Oral ◽  
Healthy Control

Objective Iron supplementation plays a major role in erythropoietin-treated end-stage renal disease patients. For peritoneal dialysis (PD) patients, oral iron substitution is more convenient than intravenous therapy. However, disturbed iron absorption and adverse effects may be limiting factors for oral treatment. Nevertheless, we compared the response to a high-dose and low-dose oral iron absorption test between PD patients and healthy control subjects. Patients and Interventions In 34 PD patients and 15 healthy control subjects, blood samples were taken at baseline as well as 2, 4, and 8 hours after oral intake of 4 tablets iron sulfate (105 mg elemental iron per tablet). In a subgroup of 6 PD patients and 6 control subjects, the oral iron absorption test was repeated using 1 tablet iron sulfate. Results There was no significant difference in the increase in serum iron during the test between the two groups. As known for healthy subjects, iron absorption was significantly better in PD patients with absolute iron deficiency compared to those with functional iron deficiency. Iron-repleted PD patients showed the lowest iron absorption, indicating that a high dose of oral iron did not overwhelm the ability of the bowel tract to reject unneeded iron. Increasing the oral iron dose from 1 to 4 tablets was followed by a better response in a small subgroup of PD patients compared to control subjects. Side effects such as nausea and vomiting occurred more frequently during high-dose oral iron in control subjects than in PD patients (20% vs 8.8%). Conclusion High-dose oral iron is well absorbed in iron-depleted PD patients. This kind of oral iron therapy should be considered in some subgroups of PD patients with iron deficiency, particularly in those patients with poor vascularization of arm veins or intolerance to intravenous iron preparations.

Low-dose oral iron absorption test in anaemic patients with and without iron deficiency determined by bone marrow iron content

2009 ◽  
Vol 63 (2) ◽  
pp. 103-111 ◽  
Author(s):  
Nanna M. Jensen ◽  
Margrethe Brandsborg ◽  
Anne M. Boesen ◽  
Hans Yde ◽  
Jens F. Dahlerup
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Iron Content ◽  
Low Dose ◽  
Iron Absorption ◽  
Oral Iron ◽  
Absorption Test ◽  
Dose Oral ◽  
Bone Marrow Iron

Iron Absorption after Single Pharmacological Oral Iron Loading Test in Patients on Chronic Peritoneal Dialysis and in Healthy Volunteers

2000 ◽  
Vol 20 (6) ◽  
pp. 662-666 ◽  
Author(s):  
Bahar Bastani ◽  
Shah Islam ◽  
Nasser Boroujerdi
Keyword(s):  
Serum Iron ◽  
Iron Absorption ◽  
Iron Concentration ◽  
Significant Rise ◽  
Oral Iron ◽  
Iron Sulfate ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Control Subjects ◽  
Serum Iron Concentration

Objective Oral iron is poorly absorbed in chronic dialysis patients. We tested the hypothesis that a superpharmacologic dose of iron sulfate (260 mg elemental iron) administered on an empty stomach results in significant iron absorption in these patients. Design A prospective open controlled trial. Setting Outpatient department of a university hospital. Patients Nine stable chronic peritoneal dialysis (PD) patients and seven normal control subjects. Method All subjects ingested a single dose of 4 tablets of iron sulfate (260 mg elemental iron total) in the morning while fasting. Outcome Measures Serum iron concentrations at baseline, and at 2 and 4 hours after the oral dose were compared between the two groups. Results The control group showed a significant rise in mean [± standard error (SE)] serum iron concentration, from a baseline value of 76.5 ± 7 μg/dL to 191 ± 10.5 μg/dL at 2 hours and to 190 ± 24 μg/dL at 4 hours. This result represents a percentage rise of 164% ± 32% at 2 hours and 152% ± 28.5% at 4 hours. In the PD patients, a significant rise in serum iron concentration was also seen, from a baseline value of 64 ± 8 μg/dL to 130 ± 3 μg/dL at 2 hours and 111 ± 18 μg/dL at 4 hours. This result represents a percentage rise of 105% ± 29% at 2 hours and 77% ± 23.5% at 4 hours. However, the absolute change in serum iron concentration in PD patients at 2 and 4 hours was approximately equal to 50% of the change in control subjects at those time points. None of the PD patients experienced gastrointestinal side effects; 4 control subjects experienced mild side effects. Conclusion Despite impaired oral iron absorption in chronic dialysis patients, a large pharmacologic dose given orally can result in significant iron absorption and may prove to be a more efficient means of oral iron supplementation therapy in these patients.

scholarly journals Oral high-dose sucrosomial iron vs intravenous iron in sideropenic anemia patients intolerant/refractory to iron sulfate: a multicentric randomized study

2020 ◽  
Author(s):  
Giulio Giordano ◽  
Mariasanta Napolitano ◽  
Valeria Di Battista ◽  
Alessandro Lucchesi
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Randomized Study ◽  
Intravenous Iron ◽  
Cost Effective ◽  
Oral Iron ◽  
Iron Sulfate ◽  
Deficiency Anemia ◽  
High Dose ◽  
Iron Administration

AbstractIron deficiency anemia is among the most frequent causes of disability. Intravenous iron is the quickest way to correct iron deficiency, bypassing the bottleneck of iron intestinal absorption, the only true mechanism of iron balance regulation in human body. Intravenous iron administration is suggested in patients who are refractory/intolerant to oral iron sulfate. However, the intravenous way of iron administration requires several precautions; as the in-hospital administration requires a resuscitation service, as imposed in Europe by the European Medicine Agency, it is very expensive and negatively affects patient’s perceived quality of life. A new oral iron formulation, Sucrosomial iron, bypassing the normal way of absorption, seems to be cost-effective in correcting iron deficiency anemia at doses higher than those usually effective with other oral iron formulations. In this multicentric randomized study, we analyze the cost-effectiveness of intravenous sodium ferrigluconate vs oral Sucrosomial iron in patients with iron deficiency anemia refractory/intolerant to oral iron sulfate without other interfering factors on iron absorption.

Low-dose oral iron absorption test: establishment of a reference interval

1998 ◽  
Vol 58 (6) ◽  
pp. 511-520 ◽  
Author(s):  
N .M Jensen ◽  
M. Brandsborg ◽  
A.M Boesen ◽  
H. Yde ◽  
J. F Dahlerup
Keyword(s):  
Low Dose ◽  
Iron Absorption ◽  
Reference Interval ◽  
Oral Iron ◽  
Absorption Test ◽  
Dose Oral

Oral iron absorption test in children with celiac disease and iron deficiency anemia: New insight for a forgotten test

2014 ◽  
Vol 46 ◽  
pp. e114
Author(s):  
Giuseppe Antonio Mazza ◽  
Giulia Paolella ◽  
Luisa Pedrelli ◽  
Elisabetta Battaglia ◽  
Laura Giancotti ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Absorption ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Absorption Test

Baseline hepcidin measurement in the differential diagnosis of anaemia for elderly patients and its correlation with the increment of transferrin saturation following an oral iron absorption test

2018 ◽  
Vol 57 (2) ◽  
pp. 250-258 ◽  
Author(s):  
Fleur Wolff ◽  
Sandra De Breucker ◽  
Thierry Pepersack ◽  
Nathalie Compté ◽  
Christian Mélot ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Elderly Patients ◽  
Iron Absorption ◽  
Transferrin Saturation ◽  
Multivariable Analysis ◽  
Relative Increase ◽  
Primary Objective ◽  
Oral Iron ◽  
Absorption Test ◽  
Spearman Coefficient

Abstract Background Anaemia is often multifactorial in the elderly, with a frequent association between iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD). The primary objective of our study was to investigate whether baseline hepcidin measurement could be useful for identifying iron deficiency (ID) in anaemic elderly patients. The secondary objective was to assess whether baseline hepcidin concentrations correlated with the relative increase of transferrin saturation (TS) after an oral iron absorption test (OIAT). Methods Blood samples were collected between 7:30 am and 10:00 am in 328 geriatric outpatients, 102 underwent the OIAT. Types of anaemia were classified according biochemical and clinical criteria. TS and hepcidin were measured at baseline and 4 h after the iron dose. The ability of baseline hepcidin measurement to highlight ID in elderly anaemic patients was assessed using a receiver operator curve (ROC) analysis. Correlations between baseline hepcidin levels and the increment of TS following the OIAT were investigated using the Spearman coefficient. Results Among 328 included patients, 78 (23.8%) suffered from anaemia; 13 (4.0%), 19 (5.8%), 27 (8.2%) and 19 (5.8%) patients fulfilled criteria for IDA, IDA/ACD, ACD and unexplained anaemia, respectively. By multivariable analysis, creatinine, C-reactive protein, ferritin, Delta TS and Delta hepcidin were independently associated with baseline hepcidin concentrations. The area under the ROC curve (95% confidence interval) was 0.900 (0.830–0.970) for baseline hepcidin measurement. Baseline hepcidin levels correlated negatively with the relative increase in TS with a Spearman coefficient of −0.742. Conclusions Baseline hepcidin levels could be a useful tool to identify ID in anaemic elderly patients and may predict acute iron response following OIAT.

scholarly journals Severe Symptomatic Hypophosphataemia as a Complication of Parenteral Iron Replacement

2020 ◽  
Author(s):  
Kevin Kim-Jun Teh ◽  
Matthew Bingfeng Chuah ◽  
Shu-Wen Tay ◽  
Amanda Yuan-Ling Lim ◽  
Joan Joo-Ching Koo
Keyword(s):  
Iron Deficiency ◽  
Fibroblast Growth Factor 23 ◽  
Elevated Serum ◽  
Serum Levels ◽  
Oral Iron ◽  
Ferric Carboxymaltose ◽  
High Dose ◽  
Dose Oral ◽  
Specific Symptoms ◽  
Iron Replacement

Parental iron replacement is given to patients with severe iron deficiency or intolerance to oral iron. Hypophosphataemia has been reported to occur as a complication of parental iron replacement, and is postulated to be related to the carbohydrate moieties used in the parenteral preparations. Hypophosphataemia is under-diagnosed as symptoms such as fatigue, muscle weakness and poor effort tolerance mimic anaemia. Severe hypophosphataemia (<0.32 mmol/l) can result in significant complications such as confusion, rhabdomyolysis and arrhythmias. We report a patient with recurrent admissions for non-specific symptoms attributed to iron deficiency anaemia who received multiple doses of parenteral ferric carboxymaltose (FCM). He was found to have severe hypophosphataemia, with further evaluation showing increased renal phosphate wasting and elevated serum levels of fibroblast-growth-factor 23 (FGF23). FCM was stopped and he was given high-dose oral iron supplementation, with no further episodes of hypophosphataemia.

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