Recent experience with high-dose intravenous iron administration

It is necessary to provide adequate amounts of bioavailable iron to correct any deficit and maintain body iron stores in anemic patients with chronic kidney disease (CKD). Although dosing regimens for intravenous iron sucrose exist, simplification of these regimens may produce financial savings and reduce the time commitment of both patients and clinicians. We have explored high-dose (500 mg or greater) intravenous iron sucrose regimens in patients with CKD and summarize our findings here. Three studies used 500 mg intravenous iron sucrose doses on 2 or more successive days, and one study examined the feasibility of a single total dose infusion of 1000 mg. We conclude that patients do not tolerate 1000 mg doses as a single infusion. On the other hand, a dosing regimen of 500 mg iron sucrose given intravenously over 3 h on successive days is safe and effective in replenishing and maintaining body iron stores. Finally, in anemic CKD patients not receiving erythropoietic hormone therapy, we found an increase in hemoglobin concentrations, and no deleterious effect on glomerular filtration rate 6 months after they were treated with iron sucrose.