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Published on: March 14, 2017
Intravenous iron supplementation in children on hemodialysis
Eveline Leijn1, Leo A H Monnens, Elisabeth A M Cornelissen
1Department of Pediatric Nephrology, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Insights
Intravenous iron-sucrose doses were evaluated in children with end-stage renal disease on hemodialysis. A dose of 1 mg/kg effectively corrects iron deficiency, while 0.3 mg/kg maintains iron levels.
Area of Science:
- Pediatric Nephrology
- Hematology
- Iron Metabolism
Background:
- Children with end-stage renal disease (ESRD) on hemodialysis (HD) frequently experience iron deficiency.
- Limited data exists on the use of intravenous (i.v.) iron-sucrose in this pediatric population.
- This study investigated i.v. iron-sucrose dosing in children with ESRD on HD.
Purpose of the Study:
- To determine effective intravenous iron-sucrose dosages for children with end-stage renal disease undergoing hemodialysis.
- To assess the impact of different i.v. iron-sucrose doses on iron status parameters.
Main Methods:
- Fourteen pediatric patients with ESRD on HD were stratified into three groups based on iron status.
- Iron-deficient patients received either 3 mg/kg/dialysis or 1 mg/kg/dialysis of iron-sucrose.
- Iron-replete patients received 0.3 mg/kg/dialysis, while iron-overloaded patients received no iron treatment.
Main Results:
- An initial dose of 3 mg/kg/dialysis in iron-deficient patients led to potential iron overload.
- A reduced dose of 1 mg/kg/dialysis for iron deficiency significantly increased ferritin levels (median from 186 to 343 microg/L, p<0.001).
- A dose of 0.3 mg/kg/dialysis maintained adequate iron levels in iron-replete patients.
Conclusions:
- The intravenous iron-sucrose dosage of 3 mg/kg/dialysis may cause iron overload in pediatric patients with ESRD on HD.
- A dosage of 1 mg/kg/dialysis appears effective for iron deficiency correction therapy.
- A dosage of 0.3 mg/kg/dialysis is suitable for iron maintenance therapy in this population.
Background:
Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in children with ESRD on HD and the effect on iron status measured.
Methods:
Fourteen patients were divided into three groups according to their actual iron status. Group A--iron deficient (ferritin (F)<100 microg/L, or F 100-400 microg/L and transferrin saturation (TSAT)<20%). These patients were treated with i.v. iron-sucrose 3 mg/kg/dialysis. Group B--iron-replete (F 100-400 microg/L and TSAT> or =20%, or TSAT>50%). These patients received 0.3 mg/kg/dialysis iron-sucrose. Group C--possible iron-overloaded (F>400 microg/L). These patients were not treated with iron.
Results:
Group A--3 mg/kg/dialysis of iron-sucrose resulted in a major increase in F, indicating possible iron overload. Therefore, the iron-deficient patients received 1 mg/kg/dialysis iron-sucrose during 22 periods of 2-14 (mean 5) weeks: the median F increased from 186 to 343 microg/L (p<0.001). Group B--0.3 mg/kg/dialysis iron-sucrose resulted in adequate iron levels during 22 periods of 2-60 (mean 9) weeks.
Conclusion:
In children, 3 mg/kg/dialysis iron-sucrose complex results in a possible iron overload. Dosage of 1 mg/kg/dialysis and 0.3 mg/kg/dialysis seem adequate for correction and maintenance therapy respectively.
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