Renal - Intravenous Iron Therapy for patients with Kidney Disease

Why do I need iron treatment?

Iron is important for keeping your blood healthy. If you do not have enough iron, you can feel tired, short of breath and become anaemic. Being anaemic can also put extra pressure on your heart and limit your level of physical activity.

If you have kidney problems, you may need some extra iron for the following reasons:

• You may not get enough iron in your diet
• You may not absorb enough iron through your gut
• You may lose blood for example when you have blood tests or are on haemodialysis treatment

If you are on treatment for anaemia, e.g., EPO/ESA/Aranesp/ Roxadustat/Evrenzo, you will need to have good amounts of iron present to help make new red blood cells.

What type of iron will I be given and how?

There are various types of iron infusions available. At Salford Royal Hospital we use Ferric derisomaltose Pharmacosmos infusion (previously known as Monofer).

This is the same as Ferritin which is found naturally in the body.

Are there any alternatives to iron infusions?

If you do not wish to have iron infusions, you can take iron tablets instead, e.g. ferrous sulphate or ferrous gluconate. These may not treat your anaemia as well as iron infusions.
 
Some people have side effects from iron tablets which means that they prefer to have the iron infusions.

I have had iron before - why do I need more?

Patients sometimes need to have repeat iron infusions every few months to keep your iron levels at the right level.

We will check your blood tests at your next clinic appointment to see if your iron levels are low, and whether you need another infusion.

I have had iron before and had a reaction to it

If you think you might have had an allergic reaction to iron infusions in the past, you must inform the team straightaway as you may not be able to have iron infusions.

You should not receive Ferric derisomaltose Pharmacosmos treatment if you have experienced serious allergic (hypersensitivity) reactions to other injectable iron preparations.

What will happen if I don’t wish to or can't have iron infusions?

If you do not wish to or can't have iron infusions, you could have iron tablets instead, but they may not work so well and you may experience side effects. You may remain anaemic and even require a blood transfusion to correct your anaemia. Blood transfusions are associated with some risks.

If you do not wish to have iron treatment or have any questions about it, then please discuss this with your kidney doctor or nurse.

What if I am pregnant or planning to have a baby?

There is limited information on the use of Ferric derisomaltose in pregnant women – please discuss with your doctor.

What if I am breastfeeding?

If you are breastfeeding, please ask your doctor for advice before you receive the iron infusion. If is unlikely that Ferric derisomaltose Pharmacosmos causes a risk to your baby.

What will happen after I finish my iron infusions?

We will check your iron and anaemia levels at your next clinic appointment to see whether your anaemia is improving.

Further information

If you have any questions about the Ferric derisomaltose Pharmacosmos treatment, please contact the Chronic Kidney Disease Team on 0161 206 1882.

How do I know when to come for my treatment?

When the kidney team have checked your blood tests, they request an appointment for you to have some iron replacement treatment.

You will receive an appointment letter in the post containing details of the date and location to attend for your
iron treatment.

For questions/queries concerning appointments, please contact 0161 206 8483.

What happens when I receive my iron treatment – Pharmacosmos?

Iron is given through a drip whilst you are in a hospital/ clinic area. Kidney patients who need an iron infusion are admitted to our clinic either at Salford Royal Hospital or Rochdale Infirmary.

You will be sent a map with your appointment letter, which will include where to attend upon arrival for your infusion.
Before you receive your iron infusion, you will have your blood pressure, pulse and temperature recorded. This is to check that you are well enough to have your iron infusion. If you have signs of infections, your treatment may need to be delayed.

A small tube (cannula) will then be put into a vein in your arm/ hand and the infusion of iron will be attached. The dose that you need to have will be guided by your weight.

Once started, the infusion treatment can take up to one and a half hours. If you experience any tingling, swelling or other sensations during the infusion, please tell your nurse.

For your own safety, you must stay in hospital and be observed for 30 minutes after your iron infusion to check that you don’t have any reactions or side effects.

You will be offered a drink when you are here. If you prefer you can bring your own or additional refreshments. One relative will be able to accompany you for your treatment.

Once the infusion is finished, the cannula will be removed, and a dressing will cover the site where it was. Sometimes bruising may occur but this is usually mild.

Your blood pressure, pulse and temperature will be checked again before you leave the hospital.

Possible side effects of Ferric derisomaltose Pharmacosmos?

Like all medicine, Ferric derisomaltose Pharmacosmos can cause side effects, although not everyone gets them.

Allergic reactions

Severe allergic reactions may occur, however they are rare.

Tell your doctor or nurse immediately if you experience any of the following signs and symptoms that may indicate a serious allergic reaction: swollen face, tongue or pharynx, difficulty to swallow, hives and difficulties to breath, and chest pain which can be a sign of a potentially serious allergic reaction called Kounis syndrome.

Common (may affect up to 1 in 10 people):

• Nausea
• Skin reactions at or near injection site including redness of the skin, swelling, burning, pain, bruising, discolouration, leakage to the tissue around the site of infusion, irritation
• Rash

Uncommon (may affect up to 1 in 100 people):

• Hypersensitivity reactions with potential shortness of breath and bronchospasm
• Headache
• Numbness
• Distortion of the sense of taste
• Blurred vision
• Loss of consciousness
• Dizziness
• Fatigue
• Increased heart rate
• Low or high blood pressure
• Chest pain, back pain, pain in your muscles or joints, muscle spasms
• Stomach pain, vomiting, impaired digestion, constipation, diarrhoea
• Itching, hives, skin inflammation
• Flushing, sweating,fever, feeling cold, shivering
• Low level of phosphate in the blood
• Infection
• Liver enzymes increased
• Local inflammation of a vein
• Skin exfoliation

Rare (may affect up to 1 in 1,000 people):

• Irregular heartbeat
• Hoarseness
• Seizure
• Tremor
• Altered mental status
• Malaise

Flu-like illness (may affect up to 1 in 1,000 people) may occur a few hours to several days after injection and is typically characterised by symptoms such as high temperature, and aches and pains in the muscles and joints.

Not known

Skin discoloration at other areas of the body than the injection site. Sometimes this discoloration could be permanent.

What do I need to do before I have my iron infusions?

If you are already taking iron tablets, you must stop these 7 days before you have iron infusions.

If you wish to restart them, you should wait until at least 7 days after your iron infusions.