HDCN Article Review/Hyperlink

Sunder-Plassman G, Horl WH

Safety of intravenous injection of iron saccharate in haemodialysis patients

Nephrol Dial Transplant (Sep) 11:1797-1802 1996

This paper describes the use of IV iron saccharate in dialysis patients. The full text of this abstract is available from Oxford Press at this site.

Comment: The safety of the intravenous administration of iron is becoming an important clinical issue as these preparations are being used more frequently. Adverse reactions to these compounds may be caused by allergy, or as a result of dissociation of free iron from the parent drug. The dextran portion of the iron dextran molecule probably renders this drug the most likely of intravenous formulations to cause allergy. We recently participated in a 4 center study evaluating the safety of intravenous iron dextran, and found anaphylactoid type reactions to occur in 1.7% of patients treated (Am J Kidney Dis, in press 10/96). While the low incidence of reactions was reassuring, an ideal iron therapy would cause no such reactions.

Iron dextran binds iron more tightly than any other iron compound, and therefore cause very few reactions due to the dissociation of free iron. The other two intravenous iron compounds in common use in Europe are ferric gluconate and iron saccharate. It is likely that allergic reactions would be less common with these agents compared to iron dextran, because they lack dextran chains. However, both bind iron less tightly than iron dextran, and may cause reactions on this basis. This is especially true for ferric gluconate, as evidenced by physical chemistry studies by Geisser et al, and by a recent clinical study by Zanen et al (Nephrol Dial Transplant 11:820-824, 1996). Chemical studies indicate that iron saccharate may bind iron more tightly than ferric gluconate, while potentially avoiding allergic reactions seen with iron dextran.

This study by Sunder-Plassman and Horl sought to evaluate the safety of iron saccharate. It is the most recent of a series of investigations by these authors utilizing iron saccharate. The investigators have demonstrated that at doses of up to 100 mg of iron saccharate given rapidly IV, there is little evidence to suggest excessive release of free iron. This is an important finding which confirms the promising nature of this drug. There continues to be a great need for randomized trials comparing the various intravenous iron preparations with regard to efficacy, safety and cost. (Stephen Fishbane, M.D., Winthrop University Hospital, Mineola, NY)