Determination of iron sucrose (Venofer) or iron dextran (DexFerrum) removal by hemodialysis: an in-vitro study

BMC Nephrology

Darren W Grabe²  Harold J Manley¹ 

[1] School of Pharmacy, University of Missouri – Kansas City, Kansas City, Missouri, USA;Albany Medical College, Albany, New York, USA

关键词: clearance;    hemodialysis;    in vitro;    iron dextran;    iron sucrose;   

Others  :  1083446
DOI  :  10.1186/1471-2369-5-1

 received in 2003-03-31, accepted in 2004-01-12,  发布年份 2004

【 摘 要 】

Background

Intravenous iron is typically administered during the hemodialysis (HD) procedure. HD patients may be prescribed high-flux (HF) or high-efficiency (HE) dialysis membranes. The extent of iron sucrose and iron dextran removal by HD using HF or HE membranes and by ultrafiltration rate (UFR) is unknown.

Methods

Two in vitro HD systems were designed and constructed to determine the dialyzabiltiy of iron from a simulated blood system (SBS) containing 100 mg iron sucrose or iron dextran (system A) or 1000 mg iron sucrose (system B). Both in vitro systems utilized a

6-L

closed-loop SBS system that was subject to 4 different HD conditions conducted over 4 hours: HE membrane + 0 ml/hr UFR; HE membrane + 500 ml/hr UFR; HF membrane + 0 ml/hr UFR; HF membrane + 500 ml/hr UFR. Blood flow and dialysate flow rates were 500 ml/min and 800 ml/min, respectively. The dialysate compartment was a 192-L open system for system A and a 6-L closed-loop system for system B. Samples from the SBS and dialysate compartments were taken at various time points and iron elimination rate and HD clearance was determined. Iron removal from the SBS > 15% was considered clinically significant.

Results

The greatest percentage removal from the SBS was 13.5% and -0.03% utilizing system A and B, respectively. Iron sucrose and iron dextran dialysate concentration was below the lower limits of assay (< 2 ppm) for system A. Dialysate recovery of iron was negligible: 0 – 5.4 mg system A and 5.47 – 23.59 mg for system B. Dialyzer type or UFR did not affect iron removal.

Conclusion

HF or HE dialysis membranes do not remove clinically significant amounts of iron sucrose or dextran formulations over a 4-hour HD session. This effect remained constant even controlling for UFR up to 500 ml/hour. Therefore, iron sucrose and iron dextran are not dialyzed by HE or HF dialysis membranes irrespective of UFR.

【 授权许可】

   
2004 Manley and Grabe; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]NKF-K/DOQI: Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000. Am J Kidney Dis 37(1 Suppl 1):S182-238.
• [2]Kumpf VJ, Holland EG: Parenteral iron dextran therapy. DICP Ann Pharmacother 1990, 24:162-166.
• [3]Fishbane S, Kowalski EA: The comparative safety of intravenous iron dextran, iron saccharate, and sodium ferric gluconate. Semin Dial 2000, 13:381-4.
• [4]Venofer (iron sucrose injection) package insert American Regent Laboratories, Inc., Shirley, New York, USA 2000.
• [5]Lawrence R: Development and comparison of iron dextran products. PDA J Pharm Sci Technol 1998, 52:190-197.
• [6]Manual MA, Stewark WK, St Clair Neill GD, Hutchinson F: Loss of iron-dextran through cupraphane membrane of a disposable coil dialyser. Nephron 1972, 9:94-98.
• [7]Hatton RC, Portales IT, Finlay A, Ross EA: Removal of iron dextran by hemodialysis: an in vitro study. Am J Kidney Dis 1995, 26:327-330.
• [8]Bailie GR, Handa JJ, Tang L, Low CL, Eisele G: Minimal removal of iron-dextran by conventional haemodialysis. An in vivo study. Clin Drug Invest 1997, 14:12-15.
• [9]Bailie GR, Johnson CA, Mason NA: Parenteral iron use in the management of anemia in end-stage renal disease patients. Am J Kidney Dis 2000, 35:1-12.
• [10]Curtis J: Module IV: Hemodialysis devices. In Core curriculum for the dialysis technician. 2nd edition. Amgen Inc. Thousand Oaks, CA;
• [11]Manley HJ, Grabe DW, Norcross M, Bailie GR: The stability of iron dextran (Dexferrum) in peritoneal dialysis solution. Perit Dial Int 1998, 18:538-540.
• [12]Macdougall IC, Chandler G, Armstrong A, Breen C, Harchowal J, Cavil : Characterization of iron availability from three different IV iron preparations in dialysis patients. J Amer Soc Nephrol 1997, 8:221A.