Fishbane S, Ungureanu V-D, Maesaka JK, Kaupke CH, Lim V, Wish
The safety of intravenous iron dextran in hemodialysis patients
Am J Kidney Dis
(Oct) 28:529-534 1996
The treatment of anemia in hemodialysis patients is impeded by iron
deficiency. Fishbane et al reviewed the records of 573 hemodialysis
patients treated with iron dextran in four hemodialysis centers to
determine the incidence and type of adverse reactions. They found
that 4.7 % of patients experienced some adverse event attributable to
iron dextran. Most reactions were mild and self-limited. Dyspnea or
wheezing, itching, and chest pain were the most frequent complaints.
Hypotension was reported in 0.5 % of patients. Adverse reactions were
more frequent in patients with a history of multiple drug allergies.
Four patients (0.7 %) experienced a serious adverse event. These
serious reactions included one cardiac arrest and three episodes of
hypotension, dyspnea, or chest pain that required hospitalization.
There were no deaths.
Comment: This study is the only large and independent
assessment of the safety of the new formulation of iron dextran. The
investigation is well done and clearly reported and the results are
similar to those published for previous formulations.
The authors have made several important observations. Adverse
reactions to iron dextran are unusual and serious adverse events are
rare. Their data suggest that a history of multiple drug allergies
may predict these infrequent occurrences. Only a prospective study
could be more convincing. (George R. Aronoff, M.D., University
of Louisville, Kentucky)