Safety in iron management

Am J Kidney Dis. 2003 Jun;41(5 Suppl):18-26. doi: 10.1016/s0272-6386(03)00373-1.


Intravenous (IV) iron therapy has become an integral part of hemodialysis management during the past several decades, and the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recognize that most patients undergoing hemodialysis will require IV iron therapy on a regular basis to reach target hemoglobin (Hgb) levels. There now are three IV iron compounds available in the United States: iron dextran, sodium ferric gluconate, and iron sucrose. Although all have been proven effective for increasing Hgb/hematocrit levels, recent data show differences in their relative safety profiles. During the past two decades, more than 30 deaths have been attributed to the use of IV iron dextran. The two newer compounds available in the United States, sodium ferric gluconate and iron sucrose, have more favorable safety profiles, with the largest prospective safety comparison to date showing sodium ferric gluconate to be similar to placebo in the incidence of serious anaphylactoid-type reactions. This article reviews safety data surrounding the IV iron therapies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anaphylaxis / chemically induced
  • Anemia / etiology
  • Anemia / prevention & control*
  • Cardiovascular Diseases / chemically induced
  • Humans
  • Infections / chemically induced
  • Infusions, Intravenous / adverse effects
  • Infusions, Intravenous / mortality
  • Iron / administration & dosage*
  • Iron / adverse effects*
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy
  • Renal Dialysis / methods*
  • Survival Rate


  • Iron