A protocol for administering intravenous iron dextran in peritoneal dialysis patients.

While the use of intravenous (IV) iron dextran has been widely studied in the hemodialysis (HD) population (Fishbane, Frei, & Maesaka, 1995; Macdougall et al., 1996; Senger & Weiss, 1996; Sepandj, Jindal, West, & Hirsch, 1996), there is limited data on its use in patients on peritoneal dialysis (PD). Since PD patients do not have chronic blood loss, they become iron deficient less frequently than HD patients. As a result, many PD patients may be able to maintain adequate iron status with oral iron (at least 200 mg of elemental iron daily) (NKF-DOQI[TM] Clinical Practice Guidelines, 1997). While oral iron is the most common form of iron administered to PD patients, there are several barriers to its successful clinical use, including poor absorption, gastrointestinal side effects, and the effects of polypharmacy (Fishbane & Maesaka, 1997). PD patients who are unable to take oral iron or who remain iron deficient despite oral iron supplementation should be considered candidates for IV iron therapy.

In HD patients receiving rHuEPO therapy, small doses of frequently administered IV iron have eliminated the side effects of oral iron and have been found to effectively maintain iron stores (Fishbane et al., 1995; Macdougall et al., 1996; Senger & Weiss, 1996; Sepandj, et al., 1996). For HD patients with absolute iron deficiency (i.e., TSAT [is less than] 20% and serum ferritin [is less than] 100 ng/mL), the recently published National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI[TM]) Anemia Guidelines recommend a repletion course of 1000 mg of IV iron dextran (administered as 100 mg of IV iron dextran at every dialysis for 10 doses) (NKF-DOQI[TM] Clinical Practice Guidelines, 1997). Once the HD patient's TSAT is [is greater than or equal to] 20% and the serum ferritin is [is greater than or equal to] 100 ng/mL, 25 to 100 mg of IV iron should be administered every week for 10 weeks to treat and prevent functional iron deficiency.

However, due to the absence of convenient vascular accesses and logistical barriers, the above method of IV iron administration is not a feasible option for ambulatory PD patients. The need for the patient to be present at a dialysis center on a regular, often weekly, basis to receive IV iron can be inconvenient to the PD outpatient, as well as labor-intensive for staff members. One treatment approach that has been found to be convenient for PD patients is known as total dose infusion (TDI). This approach involves administering the total therapeutic dose of IV iron over one to two administrations. While TDI is not approved in the United States, studies have shown that it is a safe and effective method of delivering IV iron (Auerbach et al., 1988; Auerbach et al., 1998; Ahsan, 1998).

At West Coast Dialysis Center, we have implemented a protocol using TDI …