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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Intravenous iron preparations: iron gluconate and dextran Intravenous iron preparations: iron gluconate and dextran Sodium ferric gluconate (Ferrecit)

  • Increasingly used.
  • Widely available in Europe for decades but recently introduced into the US.
  • Non-dialysable, free of dextran polysaccharides.
  • Anaphylaxis extremely rare and no deaths have been reported.
  • No need of test dose during first administration.
  • Mild reactions not uncommon.
  • Usually given as 62.5–125 mg IV infusions undiluted over 5–10 min (12.5 mg/min) during consecutive dialysis sessions until 1 g administered, then weekly (while ferritin <600 ng/ml). As with iron sucrose.
  • Tolerated by iron dextran sensitive patients.
  • Can be given as larger doses to CAPD and predialysis patients (300mg 1–3 monthly, over 90 min) to avoid frequent hospital admissions, or 125 mg in 100 ml N. saline over 60 min.

Iron dextran

  • Risk of anaphylactic reactions (0.6–1.5%), but probably less commonly than previously reported.
  • Can lead to generation of antidextran antibodies (extremely infrequently).
  • Because of risk of anaphylaxis, test dose needed for first administration (20 mg diluted in 50 ml saline over 30 min).
  • Other adverse effects include itching (1.5%), dyspnoea and wheeze (1.5%), arthralgia, myalgia, fever, headache (often delayed by 24–48 h).
  • Dose on each dialysis session initially to treat iron deficiency (usually 20–100 mg, for 10–20 sessions), and then intermittently (usually weekly, fortnightly, or monthly) to maintain iron stores (approx 50–100 mg). Alternatively, 250 mg over half an hour monthly. Give at end of dialysis by slow injection or infusion.
  • In CAPD or predialysis patients 500 mg can be diluted into 250 ml saline and given over 30–60 min.
  • Total dose iron infusions of specially fractionated iron (III) dextran (20 mg/kg iron over 4–6 h) may avoid the need for repeated infusions.
  • Becoming less widely used in view of adverse reactions.

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