INFeD

According to the NKF K/DOQI guidelines, chronic kidney disease patients should have their iron status evaluated before initiating epoetin therapy to ensure adequate iron stores.2 Serum ferritin (SF) levels should be at least 100 ng/mL and transferrin saturation (TSAT) should be at least 20%.2 Sufficient iron should be administered to maintain iron parameters at or above these threshold values to achieve and maintain hemoglobin targets at 11 to 12 g/dL.2

Approximately 1000 mg of iron is required during the first 3 months of epoetin therapy, 400 mg to replace blood losses and 600 mg to support epoetin-induced production of red blood cells. Then maintenance therapy with 400 to 500 mg iron every 3 months is recommended to compensate for hemodialysis-related blood loss and prevent functional iron deficiency.2 An annual iron dose of up to 4 g could be necessary to maintain adequate iron stores in hemodialysis patients.

For adult hemodialysis patients with absolute iron deficiency (TSAT <20%, SF <100 ng/mL), the NKF K/DOQI protocol for administering IV iron dextran is 100 mg iron dextran during each dialysis session for 10 doses.2 Before starting IV iron dextran therapy, a one-time test dose of 25 mg should be administered.2

If iron parameters still are below thresholds for absolute iron deficiency, another 1 gram repletion dose is recommended. For maintenance iron therapy and prevention of functional iron deficiency during epoetin therapy, the recommended protocol for iron dextran is 25 to 100 mg every week for 10 weeks.2

If TSAT increases to 50% or more and/or SF increases to 800 ng/mL or more, IV iron therapy should be stopped for up to 3 months and iron parameters should be remeasured.2 Once iron parameters have fallen below these levels, iron therapy may be resumed at a reduced dose.2

The parenteral use of complexes of iron and carbohydrates has resulted in anaphylactic-type reactions. Deaths associated with such administration have been reported. Therefore, INFeD® should be used only in those patients in whom the indications have been clearly established and laboratory investigations confirm an iron-deficient state not amenable to oral iron therapy. Because fatal anaphylactic reactions have been reported after administration of iron dextran injection, the drug should be given only when resuscitation techniques and treatment of anaphylactic and anaphylactoid shock are readily available.