What is the appropriate dosing for iron repletion with intravenous (IV) iron sucrose in patients with End-Stage Kidney Disease (ESKD)?

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION

Venofer must only be administered intravenously either by slow injection or by infusion. The dosage of Venofer is expressed in mg of elemental iron. Each mL contains 20 mg of elemental iron. 2. 2 Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD) Administer Venofer 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session The usual total treatment course of Venofer is 1000 mg.

The appropriate dosing for iron repletion with intravenous (IV) iron sucrose in patients with End-Stage Kidney Disease (ESKD), specifically those on hemodialysis, is:

• 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes
• Or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session
• The usual total treatment course is 1000 mg 1

From the Research

Introduction to Iron Repletion in ESKD

Iron repletion is a crucial aspect of managing anemia in patients with End-Stage Kidney Disease (ESKD). Intravenous (IV) iron sucrose is one of the commonly used iron preparations for this purpose.

Dosing Considerations for IV Iron Sucrose

The appropriate dosing for IV iron sucrose in patients with ESKD is an important consideration. According to the study by 2, an accelerated regimen of high-dose IV iron sucrose therapy, where 500 mg of iron sucrose is infused over three hours on two consecutive days, is safe and effective in restoring iron stores.

Key Findings and Recommendations

• The study by 3 suggests that a total cumulative dose of 1000 mg of IV iron may be insufficient for iron repletion in a majority of patients with iron deficiency anemia, and a dose of 1500 mg may be more effective.
• The study by 4 found that IV iron sucrose at a dose of 0.5 mg/kg is noninferior to higher doses in maintaining hemoglobin levels in children, adolescents, and young adults with chronic kidney disease.
• The study by 5 demonstrated that IV iron sucrose is safe and effective in elderly patients with ESKD, with no significant differences in adverse events or efficacy compared to younger adults.
• According to 6, doses of 100 mg of iron sucrose can be administered over several minutes, and larger doses up to 300 mg can be administered within 60 minutes.

Treatment and Dosing Guidelines

• IV iron sucrose can be administered in doses of 100 mg to 300 mg, depending on the patient's iron deficit and clinical response.
• The treatment regimen may involve repeated doses of IV iron sucrose, with the frequency and duration of treatment depending on the patient's individual needs.
• It is essential to monitor patients for adverse events, such as hypotension, nausea, and exanthema, although these are extremely uncommon with iron sucrose.

Caveats and Considerations

• The choice of IV iron preparation and dosing regimen should be individualized based on the patient's specific needs and medical history.
• Patients with a history of intolerance to other parenteral iron products may still be able to tolerate iron sucrose, as it has a lower incidence of life-threatening anaphylactoid reactions.
• Regular monitoring of hemoglobin, transferrin saturation, and ferritin levels is necessary to assess the efficacy of iron therapy and adjust the dosing regimen as needed.