Safety of total dose iron dextran infusion in geriatric patients with chronic kidney disease and iron deficiency anemia |
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Authors: | Neville R Dossabhoy Steven Turley Rebecca Gascoyne Mihaly Tapolyai Karina Sulaiman |
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Affiliation: | 1. Department of Medicine, Louisiana State University School of Medicine – Shreveport
LAUSA;2. Department of Medicine, Overton Brooks Veteran Affairs Medical Center – Shreveport
LAUSA;3. Department of Surgery, Northern Indiana HealthCare System – Fort Wayne
INUSA;4. Department of Medicine, WJB Dorn Veteran Affairs Medical Center – Columbia
SCUSA;5. Department of Medicine, Edward Via Osteopathic School of Medicine
Carolinas Campus – Spartanburg, SCUSA |
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Abstract: | There are limited data on total dose infusion (TDI) using iron dextran in geriatric chronic kidney disease (CKD) patients with iron-deficiency anemia (IDA). Our goal was to evaluate the safety of TDI in this setting. We conducted a retrospective chart review spanning a 5 year period (2002–2007), including all patients with CKD and IDA who were treated with iron dextran TDI. Patient demographics were noted, and laboratory values for creatinine, hemoglobin and iron stores were recorded pre- and post-dose. TDI diluted in normal saline was administered intravenously over 4-6 hours after an initial test dose. One hundred fifty-three patients received a total of 250 doses of TDI (mean?±?SD?=?971?±?175?mg); age was 69?±?12 years and creatinine 3.3?±?1.9?mg/dL. All stages of CKD were represented (stage 4 commonest). Hemoglobin and iron stores improved post-TDI (P?0.001). None of the patients experienced an anaphylactic reaction or death. Adverse events (AEs) were noted in 8 out of 250 administered doses (3.2%). The most common AEs were itching, chills and back pain. One hundred and ten doses of high molecular weight (HMW) iron dextran produced 6 AEs (5.45%), whereas 140 doses of low molecular weight (LMW) iron dextran produced 2 AEs (1.43%), a non-significant trend (P?=?0.1433 by Fishers Exact Test). Iron dextran TDI is relatively safe and effective in correcting IDA in geriatric CKD patients. Fewer AEs were noted with the LMW compared to the HMW product. LMW iron dextran given as TDI can save both cost and time, helping to alleviate issues of non-compliance and patient scheduling. |
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Keywords: | Chronic kidney disease geriatrics iron deficiency anemia iron dextran safety total dose iron |
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