LETTER TO THE EDITOR
Year : 2010 | Volume
: 21 | Issue : 4 | Page : 744--745
Response to iron sucrose in dialysis patients sensitive to iron dextran
Ankur Gupta, Ambar Khaira, Manu Dogra, Sanjay Kumar Agarwal
All India Institute of Medical Sciences, New Delhi, India
All India Institute of Medical Sciences, New Delhi
|How to cite this article:|
Gupta A, Khaira A, Dogra M, Agarwal SK. Response to iron sucrose in dialysis patients sensitive to iron dextran.Saudi J Kidney Dis Transpl 2010;21:744-745
|How to cite this URL:|
Gupta A, Khaira A, Dogra M, Agarwal SK. Response to iron sucrose in dialysis patients sensitive to iron dextran. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Aug 24 ];21:744-745
Available from: http://www.sjkdt.org/text.asp?2010/21/4/744/64666
To the Editor,
In the issue of the Journal (Saudi J Kidney Dis Transpl 2009;20(2):208-11), Haddad et al reported their experience of safety and efficacy of iron sucrose in hemodialysis patients with documented hypersensitivity reactions to low molecular weight iron dextran.  The authors concluded that iron sucrose is safe as well as effective in such patients. This conclusion was based on absence of any such hypersensitivity reaction and improvement in hematocrit, serum ferritin and iron levels.
However, some of the reported data needs clarification.
The mean duration of dialysis was stated to be 50.4 (12-180) months. The study does not mention the usage of any intravenous iron prior to the use of low molecular weight dextran. Were the patients receiving oral iron earlier or this was a naive parenteral iron therapy.The percentage of patients developing hypersensitivity to low molecular weight iron dextran test dose was 7.3%. This is in sharp contrast to a meta-analysis that found severe adverse reactions with iron dextran developing in approximately 0.6% of the patients treated.  KDOQI guidelines recommend target of iron therapy as serum ferritin > 200 ng/mL and transferring saturation (TSAT) > 20% or reticulocyte hemoglobin content (CHr) > 29 pg/cell in patients of chronic kidney disease on hemodialysis.  No mention of TSAT values or CHr is given in the study.TSAT is a relatively sensitive marker of iron deficiency.The diagnosis of iron deficiency remains questionable in absence of all iron markers. No differentiation was made between absolute or functional iron deficiencies.Parathyroid hormone concentrations were not reported in the publication. Of 20% of the patients who did not achieve hematocrit of > 30%, secondary hyperparathyroidism needs to be excluded.
To conclude, this study has numerous lacunae.
The data published needs more elaboration. TSAT or CHr values needs to be mentioned whenever efficacy of iron is determined.
|1||Haddad A, Abbadi R, Marji A. Use of iron sucrose in dialysis patients sensitive to iron dextran. Saudi J Kidney Dis Transpl 2009;20:208-11.|
|2||Michael B, Coyne DW, Fishbane S, et al. So dium ferric gluconate complex in hemodialysis patients: adverse reactions compared to placebo and iron dextran. Kidney Int 2002;61: 1830-9. |
|3||National Kidney Foundation. K/DOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 2006;47:S1146.|