From the Guidelines
Venofer (iron sucrose) is recommended for the treatment of iron deficiency anemia in patients with chronic kidney disease, with a typical dose of 200 mg administered intravenously, and a maximum single dose of 200 mg, with a maximum weekly dose of 500 mg, as per the most recent guidelines 1.
Treatment Regimen
The treatment regimen for Venofer in CKD patients typically involves:
- An initial dose of 200 mg administered intravenously
- A maximum single dose of 200 mg
- A maximum weekly dose of 500 mg
- Administration during dialysis sessions for hemodialysis patients
- Administration on 5 separate occasions over 14 days for non-dialysis CKD patients
Maintenance Therapy
Maintenance therapy with Venofer involves:
- 100-200 mg every 2-4 weeks based on iron parameters and hemoglobin levels
- Targeting ferritin levels of 200-500 ng/mL and transferrin saturation of 20-30%
Monitoring and Safety
Patients should be monitored for potential side effects, including:
- Hypotension during administration
- Iron parameters should be checked regularly to avoid iron overload
- Assessment of iron status should be performed every 1-3 months in patients receiving iron and/or ESA therapy, depending on the clinical status of the patient 1.
Preference for Venofer
Venofer is preferred in CKD patients due to its lower risk of hypersensitivity reactions compared to other IV iron formulations, as suggested by the KDIGO guideline 1.
From the FDA Drug Label
Venofer is an iron replacement product indicated for the treatment of iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD). Injection: 50 mg/2.5 mL, 100 mg/5 mL, or 200 mg/10 mL (20 mg/mL) in single-dose vials.
The recommended treatment for iron deficiency anemia in patients with chronic kidney disease using Venofer (iron sucrose) is iron replacement therapy with Venofer. The dosage forms and strengths available are:
- 50 mg/2.5 mL
- 100 mg/5 mL
- 200 mg/10 mL (20 mg/mL) in single-dose vials 2. Key considerations for treatment include:
- Monitoring for signs and symptoms of hypersensitivity during and after administration
- Monitoring for signs and symptoms of hypotension during and following each administration
- Regularly monitoring hematologic responses during therapy to avoid iron overload 2.
From the Research
Treatment of Iron Deficiency Anemia in Patients with Chronic Kidney Disease using Venofer (Iron Sucrose)
- Venofer (iron sucrose) is a recommended treatment for iron deficiency anemia in patients with chronic kidney disease, particularly in those who are unable to take or do not respond to oral iron therapy 3, 4.
- Intravenous iron administration, including iron sucrose, has become a first-line treatment for iron deficiency anemia in patients with end-stage kidney disease and other conditions such as chronic heart failure and inflammatory bowel disease 3.
- The use of iron sucrose has been shown to rapidly increase hemoglobin, ferritin, and transferrin saturation levels, with an acceptable safety profile 3, 4.
- However, there are concerns about the clinical appropriateness of substituting the original iron sucrose with an iron sucrose similar due to differences in efficacy and safety 3.
Recommended Treatment Guidelines
- The recommended treatment for iron deficiency anemia in patients with chronic kidney disease includes iron supplementation, with intravenous iron supplementation being the preferred method for patients on dialysis (CKD stage 5D) 5.
- For patients with CKD stages 3-5, either intravenous or oral iron is recommended 5.
- The choice of treatment depends on factors such as goals of therapy, tolerability, convenience, and response to prior therapy 6.
Safety and Efficacy Considerations
- Intravenous iron administration may lead to severe adverse events such as anaphylaxis, and delayed complications such as infections and cardiovascular disease 7.
- Balancing safety and efficacy requires clinical judgment, and individualized treatment plans may be necessary 7.
- Recent studies have provided new evidence that more aggressive repletion of iron in patients with chronic kidney disease requiring kidney replacement therapy may provide benefits with respect to anemia management and hard clinical outcomes such as cardiovascular disease and survival 6.