The Safety of Intravenous Ferric Gluconate Self Administered During Routine Home Hemodialysis

Home hemodialysis (HHD) patients are often inconvenienced when intravenous iron preparations are administered. Formerly, these patients received their medication in the clinic on an off-dialysis day or during in-center hemodialysis (HD). For the last 2 years, 5 patients in our HHD program have been receiving intravenous ferric gluconate during their routine HD session.
Procedure:  All patients were trained in the proper administration of ferric gluconate in-center. No test dose was administered. Ferric gluconate was infused via the heparin infusion pump on their HD machine at a rate of 31.25 mg/h. Doses were of either 62.5 mg or 125 mg per session. K/DOQI guidelines for intravenous iron use were adhered to. TSATs greater than 25%, ferritin greater than 100 ng/mL and less than 800 ng/mL, and hemoglobin between 11 and 12 g% were the goals of therapy. Both loading doses (8 doses during sequential HD sessions) and maintenance doses every week or every other week were employed.
Results:  Over the last 2 years, 223 doses were administered at home. No serious reactions occurred during the course of therapy. One patient experienced minor nausea and vomiting during one dose, which was thought to be possibly related to the iron infusion. This patient subsequently received ferric gluconate again without difficulty.
Conclusion:  Ferric gluconate can be safely administered at home during HHD.