From the Guidelines
For a dialysis patient with hypoferritinemia (iron level of 29), the recommended dose of intravenous iron sucrose is typically 100 mg administered during each dialysis session, given 1-3 times weekly for a total of 1,000 mg over 10 sessions. This approach is based on the guidelines for anemia of chronic kidney disease, which suggest that regular use of small doses of IV iron can prevent iron deficiency and promote better erythropoiesis than oral iron therapy 1. The goal of iron therapy is to improve erythropoiesis, not to attain specific levels of TSAT and/or serum ferritin, and the probability that functional iron deficiency exists despite a TSAT ≥ 20% is greater in patients who require higher doses of Epoetin 1. Key considerations for administration include:
- Slow administration over 5-10 minutes to minimize adverse reactions
- Monitoring for hypotension, nausea, and allergic reactions during administration
- Adjusting the dose based on TSAT and serum ferritin levels, which should be maintained at a level of 20% and 100 ng/mL, respectively, in all patients 1
- Maintenance dosing of 100 mg every 1-2 weeks to maintain adequate iron stores after reaching target levels. It is essential to note that the levels of TSAT or serum ferritin above which patients will have iron overload are not known, and patients with transfusional hemosiderosis have a TSAT ≥ 80% 1. Therefore, monitoring TSAT and serum ferritin at least once every 3 months is crucial to optimize erythropoiesis in hemodialysis patients by adjusting the pro-rated weekly dose of IV iron to maintain adequate iron status 1.
From the Research
Iron Sucrose Dosing for Dialysis Patients
The dosing of iron sucrose for dialysis patients with hypoferritinemia (iron level of 29) can be determined based on several studies.
- The study 2 administered iron sucrose in 10 doses, each 100 mg IV push over 5 minutes, without a prior test dose, for a total dose of 1,000 mg.
- Another study 3 used two dosing regimens: a replacement regimen of 100 mg intravenous iron sucrose during 10 consecutive hemodialysis sessions, and a maintenance regimen of 100 mg intravenous iron sucrose weekly for 10 weeks.
- A clinical study 4 explored the safety and efficacy of intravenous iron sucrose in maintenance dialysis patients and found that administering 200 mg once a week for 4 weeks, followed by 100 mg once a week for a further 8 weeks, was effective in increasing serum iron parameters and hemoglobin levels.
Key Considerations
- The dose and administration frequency of iron sucrose may vary depending on the patient's iron status and response to treatment 5.
- Intravenous iron sucrose can be given as large intermittent doses (loading therapy) or in smaller doses at frequent intervals (maintenance dosing regimen) 5.
- The study 4 suggests that infusing intravenous iron sucrose 200 mg every two weeks can maintain serum iron parameters and hemoglobin levels in maintenance peritoneal dialysis patients.