Safety aspects of parenteral iron in patients with end-stage renal disease

Drug Saf. 1997 Oct;17(4):241-50. doi: 10.2165/00002018-199717040-00004.


Absolute and functional iron deficiency is the most common cause of epoetin (recombinant human erythropoietin) hyporesponsiveness in renal failure patients. Diagnostic procedures for determining iron deficiency include measurement of serum iron levels, serum ferritin levels, saturation of transferrin and percentage of hypochromic red blood cells. Patients with iron deficiency should receive supplemental iron, either orally or intravenously. Adequate intravenous iron supplementation allows reduction of epoetin dosage by approximately 40%. Intravenous iron supplementation is recommended for all patients undergoing haemodialysis and for pre-dialysis and peritoneal dialysis patients with severe iron deficiency. During the maintenance phase (period of epoetin therapy after correction of iron deficiency), the use of low-dose intravenous iron supplementation (10 to 20 mg per haemodialysis treatment or 100 mg every second week) avoids iron overtreatment and minimises potential adverse effects. Depending on the degree of pre-existing iron deficiency, markedly higher iron doses are necessary during the correction phase (period of epoetin therapy after correction of iron deficiency) [e.g. intravenous iron 40 to 100 mg per haemodialysis session up to a total dose of 1000 mg]. The iron status should be monitored monthly during the correction phase and every 3 months during the maintenance phase to avoid overtreatment with intravenous iron.

Publication types

  • Review

MeSH terms

  • Anemia, Iron-Deficiency / drug therapy
  • Anemia, Iron-Deficiency / etiology
  • Citric Acid / administration & dosage
  • Citric Acid / adverse effects
  • Drug Combinations
  • Drug Monitoring
  • Erythropoietin / therapeutic use
  • Ferric Compounds / administration & dosage
  • Ferric Compounds / adverse effects
  • Ferric Oxide, Saccharated
  • Ferrous Compounds / administration & dosage
  • Ferrous Compounds / adverse effects
  • Glucaric Acid
  • Humans
  • Infusions, Intravenous
  • Injections, Intravenous
  • Iron Compounds / administration & dosage
  • Iron Compounds / adverse effects*
  • Iron Overload / complications
  • Iron-Dextran Complex / administration & dosage
  • Iron-Dextran Complex / adverse effects
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / drug therapy*
  • Sorbitol / administration & dosage
  • Sorbitol / adverse effects


  • Drug Combinations
  • Ferric Compounds
  • Ferrous Compounds
  • Iron Compounds
  • Erythropoietin
  • citric acid, iron, sorbitol drug combination
  • Citric Acid
  • Sorbitol
  • Iron-Dextran Complex
  • Ferric Oxide, Saccharated
  • Glucaric Acid
  • ferrous gluconate
  • teferrol