Sunder-Plassman G, Horl WH
Safety of intravenous injection of iron saccharate in
hemodialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1500 1996
These investigators have many years of experience with treatment with
intravenous iron saccharate, and have published many reports concerning iron
management. The primary purpose of this study was to evaluate the safety of
iron saccharate as measured by the risk of iron oversaturation. I believe
that this study was performed as a result of recent data suggesting that
ferric gluconate (another popular form of intravenous iron in Europe)
releases iron prematurely, leading to oversaturation of transferrin and
possible parenchymal deposition of iron. Physical chemical studies have
previously suggested that iron saccharate and iron dextran bind iron more
tightly than ferric gluconate, and may prevent the risk of oversaturation.
10,20,40 and 100 mg doses of iron saccharate were administered by a 1 minute
iv push at the end of dialysis treatments. Iron parameters were tested over
the ensuing 30 minutes. The serum iron concentration peaked at one minute
with all doses, in a dose-dependent manner. The same pattern was found for
the transferrin saturation, which importantly did not exceed 100%
(oversaturation) for any dose. Of note, in patients with a serum transferrin
concentration of < 180 mg/dl, iron saturation did occur with the 100 mg
dose.
The authors conclude that the lower doses are without risk of iron
oversaturation, and that the safety of iron saccharate may be explained by
these findings.
Comment: Oversaturation of transferrin is an interesting concept, and
may be
an important one clinically. Transferrin delivers iron to storage and
functional tissues in an orderly process involving receptor mediated uptake.
Iron overload, deposition of iron in parenchymal tissues, may occur if
transferrin is oversaturated, and the excess iron is deposited passively in
vital tissues. Ferric gluconate has been used for years in Europe, and is in
clinical testing in the United States. One potential problem with it has
been
that compared to iron saccharate or iron dextran, it releases iron too
easily. A recent report from Europe supports this contention. This study by
Sunder-Plassman and Horl is consistent with physical chemical studies
demonstrating that iron saccharate binds iron tightly, and prevent iron
oversaturation. Will this make iron saccharate a safer drug for patients
than
ferric gluconate or iron dextran? Undetermined...
(Stephen Fishbane, M.D., Winthrop University Hospital, Mineola, NY)
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