Oral versus Intravenous Iron Supplementation in Peritoneal Dialysis Patients

The vast majority of erythropoietin (EPO)–treated peritoneal dialysis (PD) patients require iron supplementation. Most authors and clinical practice guidelines recommend primary oral iron supplementation in PD patients because it is more practical and less expensive. However, numerous studies have clearly demonstrated that oral iron therapy is unable to maintain EPO-treated PD patients in positive iron balance. Once patients become iron-deficient, intravenous iron administration has been found to more effectively augment iron stores and hematologic response than does oral therapy. We recently performed a prospective, cross-over trial in 28 iron-replete PD patients and showed that twice-monthly outpatient iron polymaltose infusions (200 mg) were a practical and safe alternative to oral iron. That treatment produced significant increases in hemoglobin concentration and body iron stores. The additional expense of intravenous iron therapy was completely offset by reductions in EPO dosage. Careful monitoring of iron stores is important in patients receiving intravenous iron supplementation in view of epidemiologic links with infection and cardiovascular disease. Nevertheless, a growing body of evidence suggests that, as has been found for hemodialysis patients, intravenous iron therapy is superior to oral iron supplementation in EPO-treated PD patients.

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Intravenous versus Oral Iron Supplementation in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080702702s44 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 255-260

Author(s):

David W. Johnson

Keyword(s):

Peritoneal Dialysis ◽

Iron Supplementation ◽

Heme Iron ◽

Oral Iron ◽

Iron Loading ◽

Careful Monitoring ◽

Iron Stores ◽

Iron Deficient ◽

Gastrointestinal Intolerance ◽

Iv Iron

Iron supplementation is required in a preponderance of peritoneal dialysis (PD) patients treated with erythropoietic stimulatory agents (ESAs). Although many authors and clinical practice guidelines recommend primary oral iron supplementation in ESA-treated PD patients, numerous studies have clearly demonstrated that, because of a combination of poor bioavailability of oral iron, gastrointestinal intolerance, and noncompliance, oral iron supplementation is insufficient for maintaining a positive iron balance in these patients over time. Controlled trials have demonstrated that, in iron-deficient and iron-replete PD patients alike, intravenous (IV) iron supplementation results in superior iron stores and hemoglobin levels with fewer side effects than oral iron produces. Careful monitoring of iron stores in patients receiving IV iron supplementation is important in view of conflicting epidemiologic links between IV iron loading and infection and cardiovascular disease. Emerging new iron therapies such as heme iron polypeptide and ferumoxytol may further enhance the tolerability, efficacy, and ease of administration of iron in PD patients.

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Efficacy of bolus intravenous iron treatment in peritoneal dialysis patients

Medicinski pregled ◽

10.2298/mpns0502063j ◽

2005 ◽

Vol 58 (1-2) ◽

pp. 63-67 ◽

Cited By ~ 2

Author(s):

Natasa Jovanovic ◽

Mirjana Lausevic ◽

Vidosava Nesic ◽

Gordana Grujic-Adanja ◽

Biljana Stojimirovic

Keyword(s):

Peritoneal Dialysis ◽

Side Effects ◽

Blood Count ◽

Iron Supplementation ◽

Intravenous Iron ◽

Iron Therapy ◽

Chronic Peritoneal Dialysis ◽

Number Of Patients ◽

Intravenous Iron Therapy

Introduction. Normocytic, normochromic anemia is one of the first signs of chronic renal failure and it is common in patients on chronic dialysis treatment. It causes decrease in oxygen supply to tissues, increases cardiac minute volume, causes left ventricular hyperthrophy, cardiac insufficiency, disorders related to cognitive functions and immune response, and increases morbidity and mortality rates. The leading cause of anemia in patients on chronic peritoneal dialysis (PD) is iron depletion and most patients on PD need oral or parenteral iron supplementation. The aim of this study was to evaluate our first experience with bolus intravenous ferrogluconate therapy in patients on chronic peritoneal dialysis at the Nephrology Clinic of the Clinical Center of Serbia (CCS). Material and Methods. We examined 11 patients, 7 males and 4 females, mean-age 49 years (range 31 to 68 years) on chronic PD. All patients received blood transfusions, oral or intramuscular iron supplementation before 465 to 665 mg ferrogluconate therapy was given in 500 ml. saline intravenous infusion; 5 of them were on erythropoietin therapy and 2 of them started with EPO therapy after the ferrogluconate therapy. Results. The blood count improved during the first 3 months after application of bolus intravenous iron therapy (ferrogluconate); erythropoietin dose was not increased during the follow-up. Some patients suffered from side effects during infusion and 6 patients received the complete treatment. Discussion. Blood count improves in a number of patients affected by end-stage renal disease during the first months on continuous ambulatory peritoneal dialysis (CAPD) treatment. But a large number of patients on chronic CAPD treatment are iron-depleted and they require oral or parenteral substitution. Side effects and complications of intravenous iron therapy were not severe and only one patient suffered from allergic manifestations. Ferremia and blood count improved in patients who did not receive erythropoietin during the follow-up, and patients on erythropoietin therapy required lower doses after receiving the intraveonous iron therapy. Conclusion. Blood count improvement and the lack of severe side effects speak in favor of further iron supplementation with bolus intravenous iron replacement. .

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Effect of intravenous iron supplementation on iron stores in non-anemic iron-deficient patients with hereditary hemorrhagic telangiectasia

Hematology Reports ◽

10.4081/hr.2016.6348 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Torbjörn Karlsson ◽

Honar Cherif

Keyword(s):

Retrospective Study ◽

Gastrointestinal Bleeding ◽

Hereditary Hemorrhagic Telangiectasia ◽

Iron Supplementation ◽

Intravenous Iron ◽

Oral Supplementation ◽

Iron Stores ◽

Frequent Episodes ◽

Iron Deficient ◽

Intravenous Iron Supplementation

In hereditary hemorrhagic telangiectasia (HHT), frequent episodes of nasal and gastrointestinal bleeding commonly lead to irondeficiency with or without anemia. In the retrospective study presented here we assessed the iron stores, as determined by analysis of plasma ferritin, during oral and intravenous iron supplementation, respectively, in a population of iron-deficient non-anemic HHT patients who were inadequately iron-repleted by oral supplementation. A switch from oral to intravenous iron supplementation was associated with a significant increase in ferritin in this patient population.

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Oral and Intravenous Iron Therapy Differentially Alter the On- and Off-Tumor Microbiota in Anemic Colorectal Cancer Patients

Cancers ◽

10.3390/cancers13061341 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1341

Author(s):

Oliver Phipps ◽

Hafid O. Al-Hassi ◽

Mohammed N. Quraishi ◽

Edward A. Dickson ◽

Jonathan Segal ◽

...

Keyword(s):

Colorectal Cancer ◽

Ferrous Sulphate ◽

Intravenous Iron ◽

Oral Iron ◽

Iron Therapy ◽

Deficiency Anemia ◽

Ferric Carboxymaltose ◽

Β Diversity ◽

Post Surgery ◽

Intravenous Iron Therapy

Iron deficiency anemia is a common complication of colorectal cancer and may require iron therapy. Oral iron can increase the iron available to gut bacteria and may alter the colonic microbiota. We performed an intervention study to compare oral and intravenous iron therapy on the colonic tumor-associated (on-tumor) and paired non-tumor-associated adjacent (off-tumor) microbiota. Anemic patients with colorectal adenocarcinoma received either oral ferrous sulphate (n = 16) or intravenous ferric carboxymaltose (n = 24). On- and off-tumor biopsies were obtained post-surgery and microbial profiling was performed using 16S ribosomal RNA analysis. Off-tumor α- and β-diversity were significantly different between iron treatment groups. No differences in on-tumor diversity were observed. Off-tumor microbiota of oral iron-treated patients showed higher abundances of the orders Clostridiales, Cytophagales, and Anaeroplasmatales compared to intravenous iron-treated patients. The on-tumor microbiota was enriched with the orders Lactobacillales and Alteromonadales in the oral and intravenous iron groups, respectively. The on- and off-tumor microbiota associated with intravenous iron-treated patients infers increased abundances of enzymes involved in iron sequestration and anti-inflammatory/oncogenic metabolite production, compared to oral iron-treated patients. Collectively, this suggests that intravenous iron may be a more appropriate therapy to limit adverse microbial outcomes compared to oral iron.

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Intravenous infusion of total dose iron is superior to oral iron in treatment of anemia in peritoneal dialysis patients: a single center comparative study.

Journal of the American Society of Nephrology ◽

10.1681/asn.v94664 ◽

1998 ◽

Vol 9 (4) ◽

pp. 664-668 ◽

Cited By ~ 1

Author(s):

N Ahsan

Keyword(s):

Peritoneal Dialysis ◽

Total Dose ◽

Intravenous Infusion ◽

Iron Supplementation ◽

Transferrin Saturation ◽

Intravenous Iron ◽

Outpatient Setting ◽

Oral Iron ◽

Human Erythropoietin ◽

Oral Group

In the treatment of anemia of chronic renal failure, the most common cause of recombinant human erythropoietin (rhEPO) resistance is iron deficiency. In peritoneal dialysis (PD) patients, oral iron therapy is an accepted and convenient method of iron supplementation. The effectiveness of oral iron, however, is limited by many factors, including gastrointestinal side effects and poor gastric absorption. This study prospectively compared the efficacy of single intravenous infusion of total dose iron (ITDI group) given in an outpatient setting with oral iron (oral group) for the treatment of anemia in PD patients. Twenty-five adult stable PD patients with baseline hematocrit 25 to 35% were entered into the study. Thirteen patients with serum transferrin saturation (TSAT) < 25% received ITDI, and 12 patients with TSAT between 25 and 35% received oral iron. One patient in the oral group received emergent blood transfusion and was excluded from analysis. Hematocrit and iron indices were measured at monthly intervals. Doses of rhEPO were adjusted monthly to maintain target hematocrit at 35%. At the end of the study (6 mo), despite similar baseline mean hematocrit (31.0 +/- 0.9 versus 33.0 +/- 1.0%), comparable mean baseline weekly rhEPO dose (7886 +/- 1449 versus 6370 +/- 1553 U/wk), and significantly lower level of mean TSAT (11.3 +/- 3.5 versus 30.1 +/- 3.5%; P < 0.05), the ITDI group when compared with the oral group had significantly higher mean hematocrit (36.0 +/- 1.0 versus 31.4 +/- 1.1%; P < 0.05) and TSAT (33.7 +/- 3.7 versus 22.6 +/- 4.0%; P < 0.05) values. In addition, the final mean dose of weekly rhEPO was significantly lower in the ITDI group (4799 +/- 981 versus 9998 +/- 1027 U/wk; P < 0.05). No patient in the ITDI group developed an adverse reaction to intravenous iron. It is concluded that ITDI represents a more efficacious method of iron supplementation in PD patients receiving rhEPO. Moreover, ITDI is safe and well tolerated and can be administered in an outpatient setting.

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Long-Term Efficacy of Postpartum Intravenous Iron Therapy

BioMed Research International ◽

10.1155/2014/815437 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Nadine Becuzzi ◽

Roland Zimmermann ◽

Alexander Krafft

Keyword(s):

Single Injection ◽

Intravenous Iron ◽

Oral Iron ◽

Iron Stores ◽

Lower Baseline ◽

Baseline Haemoglobin ◽

Oral Group ◽

Potential Benefits ◽

Intravenous Iron Therapy

Background. The potential benefits of administering a dose of intravenous iron in patients with moderate postpartum anaemia rather than oral iron alone remains unproven.Aims.To determine whether a single injection of intravenous iron followed by a 6-week course of oral iron is as effective over 6 months in restoring normal haemoglobin levels and replenishing iron stores in women with moderate postpartum anaemia as a course of oral iron alone in women with mild postpartum anaemia.Materials and Methods. Retrospective two-arm cohort study in women with mild postpartum anaemia (haemoglobin 9.6–10.5 g/dL) prescribed iron daily for 6 weeks (N=150) and women with moderate postpartum anaemia (haemoglobin 8.5–9.5 g/dL), given a single 500 mg injection of intravenous iron followed by iron daily for 6 weeks (N=75). Haemoglobin and ferritin were measured 6 months postpartum.Results. Haemoglobin returned to similar mean levels in both groups. Ferritin levels were statistically significantly higher in the intravenous + oral group (57.7±49.3 μg/L versus32.9±20.1 μg/L).Conclusions.Despite lower baseline haemoglobin, intravenous iron carboxymaltose was superior to oral iron alone in replenishing iron stores in moderate postpartum anaemia and may prove similarly beneficial in mild postpartum anaemia.

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