HDCN Article Review/Hyperlink

St. Peter W, Lambrecth LJ, Macres M

Randomized cross-over study of adverse reactions and cost implications of intravenous push compared with infusion of iron dextran in hemodialysis patients

Am J Kidney Dis (Oct) 28:523-528 1996

The package insert for parenteral iron dextran recommends administration by IV push at a rate not to exceed 50 ml/min. There has been a sense at some centers that the potential for adverse reactions could be decreased by diluting the drug and administering it slowly by IV infusion. This report details a study comparing these two methods of drug administration.

Ten patients were given iron dextran intravenously either as a 100 mg IV push over two minutes, or as an infusion mixed in 50 ml of normal saline over 30 minutes by an infusion pump. The study lasted for 4 consecutive treatments. On each subsequent treatment day, the method of administration was alternated, creating an effective cross over study design. Seven patients completed the four dose study. No differences were found between the methods in blood pressure, pulse, or adverse events. In addition, there was no difference in nursing time, or the number of needles and syringes used. The only significant cost difference was related to the use of IV tubing and a piggyback set for the infusion method. The authors concluded that intravenous push is as safe and, and is cost effective compared to infusion of iron dextran.

Comment: This was a very small study, involving few patients studied for a short time period. Nonetheless, I think the results confirm to some extent the relative safety and cost effectiveness of the IV push method. There is really no biologic reason to expect dilution to lower the risk of adverse events. Most significant reactions to IV iron dextran are due to direct release of mediators from mast cells. The stimulus for release is not known. One theory is that some vials of iron dextran contain a small quantity of free iron which leads to degranulation. Whether the reactions are true anaphylaxis, or related to free iron, IV push should not lead to a greater risk for reactions. (Stephen Fishbane, M.D., Winthrop University Hospital, Mineola, NY)