Intravenous Iron Supplementation in Korean Children on Chronic Dialysis
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Purpose : Limited information is available on experiences of intravenous iron treatment in children. In this study, iron sucrose was administered intravenously to determine its effect, the factors predicting outcome, and safety in children on chronic dialysis. Methods : Twenty-one children whose serum ferritin levels were less than 100 ng/mL or transferrin saturations (TSAT) were less than 20% were enrolled. In 12 children on peritoneal dialysis (PD), the drug was infused intravenously as 200 mg/m2 (≤ 200 mg) at week 0, 2, 4, and 6. In 9 children on hemodialysis (HD), it was given intravenously as 8 weekly doses of 3 mg/kg (≤ 100 mg) through week 0-7. Results : After treatment, serum ferritin levels increased significantly in both groups, and TSAT rose significantly in PD group. However, hemoglobin level did not rise significantly in both groups. Children with baseline hemoglobin less than 10 g/dL or baseline TSAT less than 20% showed significantly higher rise of hemoglobin after intravenous iron treatment. To the contrary, those with higher baseline hemoglobin and TSAT levels displayed higher rise in serum ferritin after the treatment. Although no serious adverse event occurred, TSAT levels exceeding 50% were noted in 6 patients in PD group. Conclusion : This suggests that 3 mg/kg/week of intravenous iron sucrose can be used safely in children on chronic HD, but 200 mg/m2 every other week may incur excessive TSAT level in some patients on chronic PD.
Abstract
Purpose : Limited information is available on experiences of intravenous iron treatment in children. In this study, iron sucrose was administered intravenously to determine its effect, the factors predicting outcome, and safety in children on chronic dialysis. Methods : Twenty-one children whose serum ferritin levels were less than 100 ng/mL or transferrin saturations (TSAT) were less than 20% were enrolled. In 12 children on peritoneal dialysis (PD), the drug was infused intravenously as 200 mg/m2 (≤ 200 mg) at week 0, 2, 4, and 6. In 9 children on hemodialysis (HD), it was given intravenously as 8 weekly doses of 3 mg/kg (≤ 100 mg) through week 0-7. Results : After treatment, serum ferritin levels increased significantly in both groups, and TSAT rose significantly in PD group. However, hemoglobin level did not rise significantly in both groups. Children with baseline hemoglobin less than 10 g/dL or baseline TSAT less than 20% showed significantly higher rise of hemoglobin after intravenous iron treatment. To the contrary, those with higher baseline hemoglobin and TSAT levels displayed higher rise in serum ferritin after the treatment. Although no serious adverse event occurred, TSAT levels exceeding 50% were noted in 6 patients in PD group. Conclusion : This suggests that 3 mg/kg/week of intravenous iron sucrose can be used safely in children on chronic HD, but 200 mg/m2 every other week may incur excessive TSAT level in some patients on chronic PD.
참고문헌 (37)
- KDOQI: National Kidney Foundation III, "Clinical practice recommendations for anemia in chronic kidney disease in children", Am J Kidney Dis, 47(3), pp.S86~S108 (2006)
- Nissenson AR, "Recombinant human erythropoietin: impact on brain and cognitive function, exercise tolerance, sexual potency, and quality of life", Semin Nephrol, 9(1), pp.25~31 (1989)
- Kausz AT, "Anemia management in patients with chronic renal insufficiency", Am J Kidney Dis, 36, pp.S39~S51 (2000)
- Rigden SP, "Recombinant human erythropoietin therapy in children maintained by haemodialysis", Pediatr Nephrol, 4, pp.618~622 (1990)
- De Palo T, "Clinical experience with darbepoietin alfa (NESP) in children undergoing hemodialysis", Pediatr Nephrol, 19, pp.337~340 (2004)
- Warady BA, "Recombinant human erythropoietin therapy in pediatric patients receiving long-term peritoneal dialysis", Pediatr Nephrol, 5, pp.718~723 (1991)
- Eschbach JW, "The anemia of chronic renal failure: pathophysiology and the effects of recombinant erythropoietin", Kidney Int, 35, pp.134~148 (1989)
- Muller-Wiefel DE, "Hemolysis and blood loss in children with chronic renal failure", Clin Nephrol, 8, pp.481~486 (1977)
- St Peter WL, "Trends in intravenous iron use among dialysis patients in the United States (1994-2002)", Am J Kidney Dis, 46, pp.650~660 (2005)
- Warady BA, "Ferrlecit Pediatric Study Group. Sodium ferric gluconate complex therapy in anemic children on hemodialysis", Pediatr Nephrol, 20, pp.1320~1327 (2005)
- Tenbrock K, "Intravenous iron treatment of renal anemia in children on hemodialysis", Pediatr Nephrol, 13, pp.580~582 (1999)
- Gillespie RS, "Intravenous iron therapy in pediatric hemodialysis patients: a meta-analysis", Pediatr Nephrol, 19, pp.662~666 (2004)
- Leijn E, "Intravenous iron supplementation in children on hemodialysis", J Nephrol, 17, pp.423~426 (2004)
- Morgan HE, "Maintenance intravenous iron therapy in pediatric hemodialysis patients", Pediatr Nephrol, 16, pp.779~783 (2001)
- Van Damme-Lombaerts R, "Erythropoietin treatment in children with renal failure", Pediatr Nephrol, 13, pp.148~152 (1999)
- Macdougall IC, "A randomized controlled study of iron supplementation in patients treated with erythropoietin", Kidney Int, 50, pp.1694~1699 (1996)
- Spinowitz BS, "The safety and efficacy of ferumoxytol therapy in anemic chronic kidney disease patients", Kidney Int, 68, pp.1801~1807 (2005)
- Domrongkitchaiporn S, "Indices of iron status in continuous ambulatory peritoneal dialysis patients", Am J Kidney Dis, 34, pp.29~35 (1999)
- Coyne D, "Iron indices: what do they really mean?", Kidney Int Suppl, 69, pp.S4~S8 (2006)
- Jones CH, "Percentage hypochromic red cells and the response to intravenous iron therapy in anaemic haemodialysis patients", Nephrol Dial Transplant, 13, pp.2873~2876 (1998)
- Bailie GR, "Hypersensitivity reactions and deaths ssociated with intravenous iron preparations", Nephrol Dial Transplant, 20, pp.1443~1449 (2005)
- Yorgin PD, "Sodium ferric gluconate therapy in renal transplant and renal failure patients", Pediatr Nephrol, 15, pp.171~175 (2000)
- Greenbaum LA, "Intravenous iron dextran and erythropoietin use in pediatric hemodialysis patients", Pediatr Nephrol, 14, pp.908~911 (2000)
- Warady BA, "Iron therapy in the pediatric hemodialysis population", Nephrol, 19, pp.655~661 (2004)
- Richardson D, "Intravenous iron for CAPD populations: proactive or reactive strategies?", Nephrol Dial Transplant, 16, pp.115~119 (2001)
- Harmeet Singh, "Effect of intravenous iron sucrose in peritoneal dialysis patients who receive erythropoiesis-stimulating agents for anemia: a randomized, controlled trial", Clin J Am Soc Nephrol, 1, pp.475~482 (2006)
- Ahsan N, "Intravenous infusion of total dose iron is superior to oral iron in treatment of anemia in peritoneal dialysis patients: a single center comparative study", J Am Soc Nephrol, 9, pp.664~668 (1998)
- Anbu AT, "Low incidence of adverse events following 90-minute and 3-minute infusions of intravenous iron sucrose in children on erythropoietin", Acta Paediatr, 94, pp.1738~1741 (2005)
- Gokal R, "Iron metabolism in haemodialysis patients: A study of the management of iron therapy and overload", Q J Med, 48, pp.369~391 (1979)
- Kletzmayr J, "Iron overload and cardiovascular complications in dialysis patients", Nephrol Dial Transplant, 17, pp.25~29 (2002)
- Kalantar-Zadeh K, "Time-dependent associations between iron and mortality in hemodialysis patients", J Am Soc Nephrol, 16, pp.3070~3080 (2005)
- Weinberg ED, "Iron withholding: A defense against infection and neoplasia", Physiol Rev, 64, pp.65~102 (1984)
- Seifert A, "Iron overload, but not treatment with desferrioxamine favours the development of septicemia in patients on maintenance hemodialysis", QJ Med, 65, pp.1015~1024 (1987)
- Hoen B, "Risk factors for bacterial infections in chronic haemodialysis adult patients: A multicenter prospective survey", Nephrol Dial Transplant, 10, pp.377~381 (1995)
- Schaller G, "Intravenous iron increases labile serum iron but does not impair forearm blood flow reactivity in dialysis patients", Kidney Int, 68, pp.2814~2822 (2005)
- Macdougall IC, "Administration of intravenous iron sucrose as a 2-minute push to CKD patients: a prospective evaluation of 2,297 injections", Am J Kidney Dis, 46, pp.283~289 (2005)
- Chandler G, "Intravenous iron sucrose: establishing a safe dose", Am J Kidney Dis, 38, pp.988~991 (2001)