Kidney patients are prone to iron deficiency, which means many of them must receive iron infusions. This has traditionally involved multiple visits to a clinic to receive three separate treatments with iron sucrose. However, a recent study has pointed to a more convenient solution, demonstrating that a single, higher dose of ferric derisomaltose (previously known as iron isomaltoside, Monoferric©) is safe and effective for kidney patients.
Iron is an important nutrient we need for general health, and it is a key ingredient in hemoglobin, a protein essential for transporting oxygen throughout our bodies. However, kidney patients often do not absorb iron well and/or have reduced ability to produce hemoglobin.
Historically, iron sucrose infusions were given to kidney patients if oral iron therapy was not tolerated or effective in improving their iron levels. The maximum dose of iron sucrose that a person can take in one session is 300 milligrams, meaning patients need to make two to three visits to a clinic to receive adequate treatment.
BC Renal’s Pharmacy and Formulary Committee wanted to understand the potential use and benefits of a new product on the market, called ferric deriosmaltose, which can be given to patients as a single infusion of 1000 milligrams. They asked some researchers within BC Renal’s provincial network, including Dr. Karen Shalansky, Dr. Kevin Kwok, and Dr. Hilary Wu, clinical pharmacy specialists at Vancouver General Hospital (VGH), to conduct a study exploring the safety and efficacy of the new product in non-dialysis chronic kidney disease (ND-CKD), peritoneal dialysis (PD), and home hemodialysis (HHD) patients.
“There wasn’t a lot of data in kidney patients, with most of the existing data focused on hematology, gastrointestinal patients, and other populations,” explains Shalansky. “We were happy to try this new iron treatment – especially because of the COVID-19 pandemic, coming into the clinic for a transfusion once versus three times is a huge advantage.”
Her team analyzed patient records of ND-CKD, PD, and HHD patients at VGH who had previously received treatment with ferric derisomaltose, analyzing both lab results and reported adverse outcomes. The results, pending publication, show that ferric derisomaltose can effectively increase patients’ iron and hemoglobin levels with minimal adverse effects. Out of 71 ferric derisomaltose infusions administered to 61 patients, there were eight (11.3%) adverse events. A small handful of patients experienced minor side effects such as dizziness or headache; there was one case each of neuropathy, asymptomatic drop in blood pressure, and right-sided chest pain, all of which resolved without treatment.
Based on the results, BC Renal has designated and funded ferric derisomaltose as an intravenous (IV) iron option for ND-CKD, PD, and HHD patients across the province.
Kwok notes that the results of this study also underscore the importance of delivering IV iron infusions slowly. Previous studies of ferric derisomaltose in other patient populations had a higher incidence of adverse effects, but he notes this may be because the infusions were delivered over a shorter period of time, as recommended by the manufacturer of the drug. The BC research team decided to deliver the infusions more slowly, which may have contributed to a lower incidence of adverse effects.
Wu says she sees these results as widely applicable and useful for the kidney community: “I think it’s great that we’re bringing awareness to this agent. Hopefully, the results of this study provide some assurance to other nephrologists, nationally or internationally, so that they can potentially use ferric derisomaltose to help patients reach their hemoglobin and iron targets in a safe and more convenient manner.”