Randomized cross-over study of adverse reactions and cost implications of intravenous push compared with infusion of iron dextran in hemodialysis patients

In many dialysis centers, iron dextran is administered by intravenous infusion rather than intravenous push (the method of administration recommended in the package insert) as a possible, but unproven, means to reduce side effects. This study was performed to determine whether there is a difference in adverse reactions between these two methods. Ten iron-deficient hemodialysis patients participated in a randomized, cross-over study of iron dextran 100 mg administered by intravenous push over 2 minutes (undiluted) or as a 30-minute intravenous infusion during the first hour of hemodialysis. Patients received a total of four doses (two by each method during four separate dialysis sessions). Blood pressure and heart rate were monitored pre-dose and at frequent intervals throughout the hemodialysis session following the dose. Patients completed adverse event surveys before and 60 minutes after the dose and prior to the next hemodialysis session. Blood pressure, heart rate, and survey data were analyzed using a Wilcoxon analysis (P ≤ 0.05 was considered significant). Seven patients received all four doses, two patients received only three doses (one due to missed hemodialysis session and one due to severe diarrhea possibly related to iron dextran), and one patient received only one dose (due to unstable clinical status). No differences in blood pressure, heart rate, or adverse events were observed between the two administration methods. A cost-minimization analysis was performed to compare the costs of each method of iron dextran administration. There were no differences in nursing time or number of syringes and needles used between the two methods. However, cost savings were observed with intravenous push administration because the intravenous tubing and intravenous piggyback were eliminated. Iron dextran can be administered by either intravenous push or intravenous infusion during the first hour of hemodialysis, with no significant differences between the two methods in terms of blood pressure or heart rate. Dialysis programs can minimize iron dextran administration costs by changing to the intravenous push method.