UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Treatment of iron deficiency in peritoneal dialysis patients

Author
Jeffrey S Berns, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Anemia is common among peritoneal dialysis patients. Anemia underlies many of the symptoms associated with reduced kidney function and is associated with increased mortality and hospitalizations [1-4]. Iron deficiency is a common reversible cause of anemia among peritoneal dialysis patients.

This topic reviews screening for and treatment of iron deficiency among peritoneal dialysis patients. Iron deficiency in hemodialysis patients and in nondialysis chronic kidney disease (CKD) patients is discussed elsewhere. (See "Treatment of iron deficiency in hemodialysis patients" and "Diagnosis of iron deficiency in chronic kidney disease".)

Indications for treatment with erythropoiesis-stimulating agents (ESAs) are discussed separately. (See "Treatment of anemia in peritoneal dialysis patients".)

EPIDEMIOLOGY AND CAUSE

Iron deficiency is more common among peritoneal dialysis patients compared with the nondialysis population. In the United States, among 17,842 patients undergoing peritoneal dialysis in 2011, 36.5 percent received intravenous (IV) iron [5]. By comparison, iron deficiency is present in 1 to 12 percent of individuals worldwide and in the United States. (See "Causes and diagnosis of iron deficiency and iron deficiency anemia in adults", section on 'Epidemiology'.)

Iron deficiency is less common among peritoneal dialysis patients compared with hemodialysis patients. In the Medicare study cited above, 36.6 percent of peritoneal dialysis patients received IV iron compared with 74.5 percent of hemodialysis patients [5].

          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Oct 13 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Ma JZ, Ebben J, Xia H, Collins AJ. Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol 1999; 10:610.
  2. Xia H, Ebben J, Ma JZ, Collins AJ. Hematocrit levels and hospitalization risks in hemodialysis patients. J Am Soc Nephrol 1999; 10:1309.
  3. Collins AJ, Li S, St Peter W, et al. Death, hospitalization, and economic associations among incident hemodialysis patients with hematocrit values of 36 to 39%. J Am Soc Nephrol 2001; 12:2465.
  4. Collins AJ, Ma JZ, Ebben J. Impact of hematocrit on morbidity and mortality. Semin Nephrol 2000; 20:345.
  5. Wetmore JB, Peng Y, Monda KL, et al. Trends in anemia management practices in patients receiving hemodialysis and peritoneal dialysis: a retrospective cohort analysis. Am J Nephrol 2015; 41:354.
  6. Pandey R, Daloul R, Coyne DW. Iron Treatment Strategies in Dialysis-Dependent CKD. Semin Nephrol 2016; 36:105.
  7. Macdougall IC, Tucker B, Thompson J, et al. A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int 1996; 50:1694.
  8. Tessitore N, Solero GP, Lippi G, et al. The role of iron status markers in predicting response to intravenous iron in haemodialysis patients on maintenance erythropoietin. Nephrol Dial Transplant 2001; 16:1416.
  9. Fishbane S, Kowalski EA, Imbriano LJ, Maesaka JK. The evaluation of iron status in hemodialysis patients. J Am Soc Nephrol 1996; 7:2654.
  10. Kalantar-Zadeh K, Höffken B, Wünsch H, et al. Diagnosis of iron deficiency anemia in renal failure patients during the post-erythropoietin era. Am J Kidney Dis 1995; 26:292.
  11. Fishbane S, Shapiro W, Dutka P, et al. A randomized trial of iron deficiency testing strategies in hemodialysis patients. Kidney Int 2001; 60:2406.
  12. Stancu S, Bârsan L, Stanciu A, Mircescu G. Can the response to iron therapy be predicted in anemic nondialysis patients with chronic kidney disease? Clin J Am Soc Nephrol 2010; 5:409.
  13. Van Wyck DB, Roppolo M, Martinez CO, et al. A randomized, controlled trial comparing IV iron sucrose to oral iron in anemic patients with nondialysis-dependent CKD. Kidney Int 2005; 68:2846.
  14. KDOQI, National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 2006; 47:S11.
  15. Ahsan N. Intravenous infusion of total dose iron is superior to oral iron in treatment of anemia in peritoneal dialysis patients: a single center comparative study. J Am Soc Nephrol 1998; 9:664.
  16. Johnson DW, Herzig KA, Gissane R, et al. A prospective crossover trial comparing intermittent intravenous and continuous oral iron supplements in peritoneal dialysis patients. Nephrol Dial Transplant 2001; 16:1879.
  17. Li H, Wang SX. Intravenous iron sucrose in peritoneal dialysis patients with renal anemia. Perit Dial Int 2008; 28:149.
  18. Shepshelovich D, Rozen-Zvi B, Avni T, et al. Intravenous Versus Oral Iron Supplementation for the Treatment of Anemia in CKD: An Updated Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 68:677.
  19. Singh H, Reed J, Noble S, et al. Effect of intravenous iron sucrose in peritoneal dialysis patients who receive erythropoiesis-stimulating agents for anemia: a randomized, controlled trial. Clin J Am Soc Nephrol 2006; 1:475.
  20. Auerbach M, Adamson JW. How we diagnose and treat iron deficiency anemia. Am J Hematol 2016; 91:31.
  21. Rodgers GM, Auerbach M, Cella D, et al. High-molecular weight iron dextran: a wolf in sheep's clothing? J Am Soc Nephrol 2008; 19:833.
  22. Auerbach M, Ballard H. Clinical use of intravenous iron: administration, efficacy, and safety. Hematology Am Soc Hematol Educ Program 2010; 2010:338.
  23. Landry R, Jacobs PM, Davis R, et al. Pharmacokinetic study of ferumoxytol: a new iron replacement therapy in normal subjects and hemodialysis patients. Am J Nephrol 2005; 25:400.
  24. Spinowitz BS, Schwenk MH, Jacobs PM, et al. The safety and efficacy of ferumoxytol therapy in anemic chronic kidney disease patients. Kidney Int 2005; 68:1801.
  25. Spinowitz BS, Kausz AT, Baptista J, et al. Ferumoxytol for treating iron deficiency anemia in CKD. J Am Soc Nephrol 2008; 19:1599.
  26. Provenzano R, Schiller B, Rao M, et al. Ferumoxytol as an intravenous iron replacement therapy in hemodialysis patients. Clin J Am Soc Nephrol 2009; 4:386.
  27. Macdougall IC, Roche A. Administration of intravenous iron sucrose as a 2-minute push to CKD patients: a prospective evaluation of 2,297 injections. Am J Kidney Dis 2005; 46:283.
  28. Schiesser D, Binet I, Tsinalis D, et al. Weekly low-dose treatment with intravenous iron sucrose maintains iron status and decreases epoetin requirement in iron-replete haemodialysis patients. Nephrol Dial Transplant 2006; 21:2841.
  29. Charytan C, Levin N, Al-Saloum M, et al. Efficacy and safety of iron sucrose for iron deficiency in patients with dialysis-associated anemia: North American clinical trial. Am J Kidney Dis 2001; 37:300.
  30. Sheashaa H, El-Husseini A, Sabry A, et al. Parenteral iron therapy in treatment of anemia in end-stage renal disease patients: a comparative study between iron saccharate and gluconate. Nephron Clin Pract 2005; 99:c97.
  31. Fishbane S. Safety in iron management. Am J Kidney Dis 2003; 41:18.
  32. Aronoff GR, Bennett WM, Blumenthal S, et al. Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens. Kidney Int 2004; 66:1193.
  33. Silverberg DS, Blum M, Peer G, et al. Intravenous ferric saccharate as an iron supplement in dialysis patients. Nephron 1996; 72:413.
  34. Bailie GR, Clark JA, Lane CE, Lane PL. Hypersensitivity reactions and deaths associated with intravenous iron preparations. Nephrol Dial Transplant 2005; 20:1443.
  35. Chandler G, Harchowal J, Macdougall IC. Intravenous iron sucrose: establishing a safe dose. Am J Kidney Dis 2001; 38:988.
  36. Faich G, Strobos J. Sodium ferric gluconate complex in sucrose: safer intravenous iron therapy than iron dextrans. Am J Kidney Dis 1999; 33:464.
  37. Nissenson AR, Lindsay RM, Swan S, et al. Sodium ferric gluconate complex in sucrose is safe and effective in hemodialysis patients: North American Clinical Trial. Am J Kidney Dis 1999; 33:471.
  38. Matzke GR. Intravenous iron supplementation in end-stage renal disease patients. Am J Kidney Dis 1999; 33:595.
  39. Fishbane S, Wagner J. Sodium ferric gluconate complex in the treatment of iron deficiency for patients on dialysis. Am J Kidney Dis 2001; 37:879.
  40. Folkert VW, Michael B, Agarwal R, et al. Chronic use of sodium ferric gluconate complex in hemodialysis patients: safety of higher-dose (> or =250 mg) administration. Am J Kidney Dis 2003; 41:651.
  41. Canavese C, Bergamo D, Ciccone G, et al. Low-dose continuous iron therapy leads to a positive iron balance and decreased serum transferrin levels in chronic haemodialysis patients. Nephrol Dial Transplant 2004; 19:1564.
  42. Grimmelt AC, Cohen CD, Fehr T, et al. Safety and tolerability of ferric carboxymaltose (FCM) for treatment of iron deficiency in patients with chronic kidney disease and in kidney transplant recipients. Clin Nephrol 2009; 71:125.
  43. Onken JE, Bregman DB, Harrington RA, et al. Ferric carboxymaltose in patients with iron-deficiency anemia and impaired renal function: the REPAIR-IDA trial. Nephrol Dial Transplant 2014; 29:833.
  44. Macdougall IC, Bock AH, Carrera F, et al. FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia. Nephrol Dial Transplant 2014; 29:2075.
  45. Kalra PA, Bhandari S, Saxena S, et al. A randomized trial of iron isomaltoside 1000 versus oral iron in non-dialysis-dependent chronic kidney disease patients with anaemia. Nephrol Dial Transplant 2016; 31:646.
  46. Jain AK, Bastani B. Safety profile of a high dose ferric gluconate in patients with severe chronic renal insufficiency. J Nephrol 2002; 15:681.
  47. Sloand JA, Shelly MA, Erenstone AL, et al. Safety and efficacy of total dose iron dextran administration in patients on home renal replacement therapies. Perit Dial Int 1998; 18:522.
  48. Prakash S, Walele A, Dimkovic N, et al. Experience with a large dose (500 mg) of intravenous iron dextran and iron saccharate in peritoneal dialysis patients. Perit Dial Int 2001; 21:290.
  49. Blaustein DA, Schwenk MH, Chattopadhyay J, et al. The safety and efficacy of an accelerated iron sucrose dosing regimen in patients with chronic kidney disease. Kidney Int Suppl 2003; :S72.
  50. Bastani B, Jain A, Pandurangan G. Incidence of side-effects associated with high-dose ferric gluconate in patients with severe chronic renal failure. Nephrology (Carlton) 2003; 8:8.
  51. Danda RS, Kirk LJ, Pergola PE. High-dose iron gluconate in chronic kidney disease patients. Nephrology (Carlton) 2004; 9:47.
  52. Kosch M, Bahner U, Bettger H, et al. A randomized, controlled parallel-group trial on efficacy and safety of iron sucrose (Venofer) vs iron gluconate (Ferrlecit) in haemodialysis patients treated with rHuEpo. Nephrol Dial Transplant 2001; 16:1239.
  53. Agarwal R, Vasavada N, Sachs NG, Chase S. Oxidative stress and renal injury with intravenous iron in patients with chronic kidney disease. Kidney Int 2004; 65:2279.