Removal of iron dextran (Cosmofer®) during hemodialysis

Abstract

SUMMARY Intravenous iron dextran is widely used in hemodialysis patients receiving erythropoietin (EPO) therapy because of its significant convenience in clinical practice. However, the amount of iron removed by hemodialysis in vivo is unknown. The purpose of this study was to measure the removal of iron dextran in patients undergoing hemodialysis. Six patients were enrolled in this study. All were stable patients treated by hemodialysis for at least 1 month. Both F6 (polysulphone membrane) and GFSplus12 (hemophane membrane) dialyzers were used sequentially in each patient. Each patient received 2 mL of low-molecular-weight iron dextran (Cosmofer® aktieselskab/aksjeselskap and supplied by Zhuhai Schwarz Pharma Company Ltd) intravenously, containing 100 mg of elemental iron, administered during the second hour of dialysis over 30 to 60 minutes. A baseline sample of fresh dialysate was collected before the commencement of dialysis. A control sample of spent dialysate was collected during the first hour of dialysis, before the infusion of low-molecular-weight iron dextran. Then, all spent dialysate after the iron dextran infusion until the end of dialysis was collected. The samples were treated with lanthanum nitrate solution, and the iron content was measured using an atomic-absorptive spectrum method. The iron concentration in the control group was 4.31 ± 2.55 µg/L. After the infusion of iron dextran, the iron concentration in the spent dialysate increased significantly, irrespective of whether an F6 or GFSplus12 dialyzer was used. However, the amount of iron eliminated through the dialyzer was minimal, less than 3% of the infusion dose. There was no significant difference in removal of iron through either the F6 or GFSplus12 dialyzer. These results indicate that the removal of iron dextran by hemodialysis when using either a polysulfphone or hemophane membrane dialyzer is negligible. It is time-efficient and convenient to administer low-molecular-weight iron dextran during hemodialysis.