Tolerability and efficacy of parenteral iron therapy in hemodialysis patients, a comparison of preparations

SUMMARY Hemodialysis patients require parenteral iron to replenish/maintain sufficient iron stores and optimize erythropoietin (EPO) use. Two parenteral iron preparations are available in the UK, iron dextran (CosmoFer) and iron sucrose (Venofer). Debate about their safety profiles continues. We performed an observational study of chronic kidney disease patients and a prospective crossover study in hemodialysis patients to examine the comparative safety and tolerability of CosmoFer and Venofer. Side effects, hemoglobin, ferritin and EPO dose were recorded. One hundred and forty‐four patients received CosmoFer (2294 doses) and 110 received Venofer (2111 doses). Fifteen reactions occurred with no anaphylactic episodes in either group. Thirty‐nine patients (28 men), mean age 60.5 years, on intravenous Venofer were converted to CosmoFer for 6 months. They were then converted back to Venofer. No differences in hemoglobin, EPO dose or ferritin levels throughout the study were observed. Side effects were minor after 546 and 507 doses of CosmoFer and Venofer (13 reactions (eight CosmoFer, five Venofer) occurred in eight patients). Conversion from Venofer to CosmoFer led to a cost saving of £77 per patient over the 6‐month study period. In this study, the two forms of therapy were equally safe and effective. Examination of a larger cohort of patients is necessary to verify these findings and potentially reassess European Best Practice Guidelines.