In this section : Renal
Diagnosis, treatment and management of UTI in children (D&G)
Kidney Biopsy Complications
Parenteral Iron for Non-HD CKD Patients
Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s
Prescribing Advice on Admission – Insulin
Sodium Glucose Transporter 2 Inhibitors (SGLT2i)
Gentamicin in Renal Replacement Therapy
Vancomycin in Renal Replacement Therapy
Haemodialysis Medication Prescribing
Contrast Associated AKI
Low Molecular Weight Heparin
Fluid Replacement in AKI
Management of Urinary Symptoms
Acute Kidney Injury (AKI)
Urinary Tract Infection
Urethral Catheterisation
Kidney Transplantation
Ureteric Colic & Renal Stones
Intravascular Catheter Related Blood Stream Infection
Care of Vascular Access
Urinary Incontinence
Peritoneal Dialysis Related Peritonitis
Parenteral Iron for Non-HD CKD Patients
Last updated 6th March 2024
Criteria | Treatment |
---|---|
Failure to respond/intolerance to oral iron Hb <100g/L Ferritin <200 and/or TSAT <20% B12 & Folate replete | Iron Isomaltoside (Monofer) IV infusion 20mg/kg up to 1.5g if over 75kh 500, 1000 or 1500mg Monofer Infusion Guideline |
Infusion takes 30 minutes with 30 minutes post treatment observation monitoring. This is given in Ambulatory Care (Referral Form) at DGRI (Outpatients), or on Ward (0900 – 1700 only) for inpatients.
Test | Frequency | Action |
---|---|---|
Haemoglobin Ferritin TIBC sats (Iron studies) | If on ESA: Monthly If not: at least 4-monthly Hb tests <4 weeks post dose underestimate the benefit. | Per box above |
If Ferritin >200 AND Hb <100 AND CRP >20 | Monitor CRP as clinical situation determines | Consider riak vs benefit of infusion, consider reason for CRP elevation. Can use iron at referrer's discretion. |
Monofer patient information: pil.5676.pdf (medicines.org.uk)
Contraindications
- Ferritin >800 (UKKA suggest review treatment if ferritin >500 to avoid exceeding 800).
- IV iron should not be used if a prior hypersensitivity to the product is documented.
- Non-iron deficiency anaemia (e.g. haemolytic anaemia)
- Iron overload or disturbances in utilisation of iron (e.g. haemochromatosis, haemosiderosis)
- Decompensated liver disease
Hypersensitivity / Caution
- The administration of IV iron can cause allergic or anaphylactoid reactions which may be potentially fatal and can occur with the first dose or with any subsequent doses. Each IV iron administration is associated with a risk of hypersensitivity reaction, therefore the number of IV iron administrations should be kept to a minimum.
- These warnings were strengthened in 2013 by the European Medicines Agency. Click here for EMA Recommendations to manage risk of allergic reactions with intravenous iron-containing medicines 2013.
- Mild allergic reactions should be managed by stopping the iron infusion and administering antihistamines
- Hypotensive episodes may occur if the iron is administered too rapidly. Patients with low iron binding capacity and/or folate deficiency are at particular risk.
- Patients must be observed closely during and post infusion and should be provided with a leaflet to take away which explains how to deal with any delayed reactions after discharge.
- Paravenous leakage / extravasation can result in permanent skin staining.
Interaction with Oral Iron Preparations
- Combined treatment with oral and IV iron may lead to the appearance of highly toxic non transferrin bound iron. Oral iron therapy should generally not be required following IV iron replacement
- It is recommended that oral iron preparations are discontinued at least 48 hours prior to IV iron infusions.
- The need for oral iron therapy should be reviewed following IV iron replacement. If deemed necessary, oral iron should not be started for at least 5 days after the last IV iron infusion.
2nd Line Options
- Patients who have not tolerated any iron preparation are at high risk of being intolerant to all so definite hypersensitivity reactions should be regarded as a contraindication to all.
- Ferrinject (iron Sucrose) is an alternative to Monofer. Ferrinject is second line due to 1. Risk of hypophosphataemia, 2. Maximum 1000mg/single dose.
- More information on GGC guideline: ida.pdf(scot.nhs.uk) and UKKA 2020 guideline
Content by Michael Kelly and Sarah Flower