Safety of intravenous iron use in chronic kidney disease

Kalra, Philip A.; Bhandari, Sunil

doi:10.1097/mnh.0000000000000263

Cited by 50Erythropoietin and Anemia TreatmentIron Metabolism and DisordersBlood transfusion and management

Safety of intravenous iron use in chronic kidney disease

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Kalra, Philip A., Bhandari, Sunil·2016·Current Opinion in Nephrology and Hypertension

DOI 10.1097/mnh.0000000000000263PMC PMC5054948

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Abstract

PURPOSE OF REVIEW: Iron deficiency anaemia (IDA) is common and associated with fatigue, reduced quality of life and poorer clinical outcomes. Treatment with oral iron is often inadequate and international guidelines recommend intravenous (i.v.) iron as the preferred option for the treatment of IDA in certain clinical situations. In this review, we assess the safety of using i.v. iron with a particular focus on patients with chronic kidney disease. RECENT FINDINGS: Recent publications have raised safety concerns regarding the incidence of serious reactions accompanying i.v. infusion, as well as the subsequent risk of infections and cardiovascular events. Methodological flaws influence the interpretation of these data that lack evidence from the use of modern irons. The latter have been investigated in several randomized control trials. SUMMARY: There is a need for better understanding and definition of the nature of i.v. iron reactions, as many are nonserious infusion reactions rather than true anaphylaxis. Retrospective identification of anaphylaxis is difficult and we suggest the importance of reanalysing data using fatalities or standardized terms as outcome measures. With the exception of high molecular weight iron dextran, serious or life-threatening reactions are rare with the use of i.v. irons, and they can be used safely for the treatment of IDA.

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These reports are in disagreement with the paper mentioned by Strom and Andreasen [6].
“Noteworthy, these reports are in disagreement with the paper mentioned by Strom and Andreasen [6]”
From Reply to “Comment on Neiser et al. Assessment of Dextran Antigenicity of Intravenous Iron Preparations with Enzyme-Linked Immunosorbent Assay (ELISA). Int. J. Mol. Sci. 2016, 17, 1185.” (2017) · cites this paper as [6]
The paper mentioned by Strom and Andreasen [6] was published online more than a month after our final draft was accepted.
“which, incidentally, was published online more than a month after our final draft was accepted.”
From Reply to “Comment on Neiser et al. Assessment of Dextran Antigenicity of Intravenous Iron Preparations with Enzyme-Linked Immunosorbent Assay (ELISA). Int. J. Mol. Sci. 2016, 17, 1185.” (2017) · cites this paper as [6]
High molecular weight iron dextran complexes, most of which are no longer marketed, display higher rates and generally more severe hypersensitivity reactions.
“the basis of this study was the general consensus that high molecular weight iron dextran complexes, most of which are no longer marketed, display higher rates and generally more severe hypersensitivity reactions [4,5,6].”
From Reply to “Comment on Neiser et al. Assessment of Dextran Antigenicity of Intravenous Iron Preparations with Enzyme-Linked Immunosorbent Assay (ELISA). Int. J. Mol. Sci. 2016, 17, 1185.” (2017) · cites this paper as [6]

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Authors: Kalra, P. A., & Bhandari, S.
Affiliations: Hull University Teaching Hospitals NHS Trust (GB)
Corresponding author: Kalra, Philip A.
ORCID: Kalra, Philip A.
Bhandari, Sunil
Venue: Current Opinion in Nephrology and Hypertension
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-11
Volume: 25
Issue: 6
Pages: 529-535
ISSN: 1062-4821 (ISSN-L)
DOI: 10.1097/mnh.0000000000000263
PMC: PMC5054948
OpenAlex: W2512898051
Cited by: 50
References: 44
Citations by year: 2025: 1 · 2024: 2 · 2023: 6 · 2022: 2 · 2021: 6 · 2020: 9 · 2019: 11 · 2018: 5 · 2017: 7 · 2016: 1
FWCI: 1.13
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
Locations: Current Opinion in Nephrology & Hypertension (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
Health Sciences › Medicine › Biochemistry › Blood transfusion and management
Keywords: intravenous iron, chronic kidney disease, iron deficiency anemia, anaphylaxis, iron dextran, infection, cardiovascular events, outcome measures
MeSH terms: Humans, Iron, Anemia, Iron-Deficiency, Renal Insufficiency, Chronic, Administration, Intravenous

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Safety of intravenous iron use in chronic kidney disease

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