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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2003  |  Volume : 14  |  Issue : 4  |  Page : 534
Iron Therapy


King Khalid University Hospital, PO Box # 2925 [38], Riyadh 11461, Saudi Arabia

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How to cite this article:
Tarif N. Iron Therapy. Saudi J Kidney Dis Transpl 2003;14:534

How to cite this URL:
Tarif N. Iron Therapy. Saudi J Kidney Dis Transpl [serial online] 2003 [cited 2019 Aug 21];14:534. Available from: http://www.sjkdt.org/text.asp?2003/14/4/534/32992
To the Editor:

In the recent June 2003 issue of the Saudi Journal of Kidney Diseases and Transplan­tation the articles by Zolezzi and Souqiyyeh acknowledge the fact that interest in iron replacement therapy for the hemodialysis (HD) patients is taking its ground in Saudi Arabia. [1],[2] I would like to mention one imp­ortant improvement and cost saving strategy in this regard; intravenous bolus [IVB] admini­stration of iron. Although iron dextran had been used as IVB, concerns regarding the side effects precluded its frequent evaluation in the literature. [3] Iron saccharate as reviewed by Zolezzi is comparatively less allergenic and has lesser other side effects. Recently, Macdougall et al gave >4000 injections of 100 mg iron saccharate to patients on HD as IVB over 1-2 minutes with no adverse reactions and significant cost saving. [4] We also recently reported our experience on the use of IVB, the first such report from Saudi Arabia. [5] We administered IVB of 100 mg iron saccharate over two minutes to 31 patients on HD and were able to significantly improve the iron stores, anemia and reduce the cost; a saving of $1064 [SR 4000] over a period of six months. A total of 537 IVB injections were given and they were not associated with any episodes of hypotension or other side effects. With this significant cost saving and lack of serious side effects it is surprising that this aspect of iron supplementation was not assessed in the recent survey. [2] We, therefore, would like to highlight the importance of IVB iron saccharate administration as a safe and tested method. Nevertheless, considering the possibility of an allergic reaction the first dose should be given as an infusion to identify such patients.

Furthermore, we would like to point out that in [Table 2] of the editorial by Zolezzi M, a total dose of infusion of 500 mg over 2-4 hours is recommended. [1] In a recent study by Chandler et al, a dose of 400 and 500 mg over two hours was associated with side effects and was not recommended as a safe dose. [6] The safety of a high dose infusion over more than two hours still needs to be assessed.

 
   References Top

1.Zolezzi M, Intravenous iron saccharate complex: guidelines for its use in the manage-ment of anemia of renal disease. Saudi J Kidney Dis Transplant 2003; 14[2]:129-33.  Back to cited text no. 1    
2.Souqiyyeh MZ, Shaheen FAM. Attitude of physicians towards iron supplementation in hemodialysis patients treated with erythro­poietin. Saudi J Kidney Dis Transplant 2003;14[2]:134-44.  Back to cited text no. 2    
3.St Peter WL, Lambrecht LJ, Macres M. Randomized cross-over study of adverse reactions and cost implications of intra­venous push compared with infusion of iron dextran in hemodialysis patients. Am J Kidney Dis 1996;28(4):523-8.  Back to cited text no. 3    
4.Macdougall IC, Chandler G, Elston O, Harchowal J. Beneficial effects of adopting an aggressive intravenous iron policy in a hemodialysis unit. Am J Kidney Dis 1999; 34(4 Suppl 2):S40-6.  Back to cited text no. 4    
5.Tarif N, Mitwalli A, Alwakeel JS, et al. Safety of intravenous bolus ferrous saccharate administration in hemodialysis patients. J Am Soc Nephrol 2001;page 414 [Abstract-2136].  Back to cited text no. 5    
6.Chandler G, Harchowal J, Macdougall IC. Intravenous iron sucrose: establishing a safe dose.AmJKidneyDis2001;38(5):988-91.  Back to cited text no. 6    

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Correspondence Address:
Nauman Tarif
King Khalid University Hospital, PO Box # 2925 [38], Riyadh 11461
Saudi Arabia
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PMID: 17657130

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