Correction of iron deficiency anaemia using IV CosmoFer in CKD patients with asthma: a prospective study.

Background: Intravenous (IV) iron is commonly used for correcting iron deficiency anaemia in patients with chronic kidney disease (CKD). There remains a concern for its use in patients with asthma as it may trigger an acute exacerbation. Pre-treatment with a single dose of parenteral hydrocortisone may obviate this risk.

Method: We carried out a prospective study of known asthmatic patients with CKD requiring single-dose iron repletion therapy. We analysed the efficacy and safety of IV CosmoFer (low molecular weight iron dextran). Twenty non-dialysis CKD patients with iron deficiency anaemia and a history of asthma were enrolled. Severity of asthma and level of control were recorded as per British Thoracic Society Guidelines and Royal Collage of Physician questionnaire, respectively. All patients received IV hydrocortisone 30 min before the test dose of CosmoFer followed by the remaining total dose. Patients were monitored for adverse reactions. Haemoglobin, serum ferritin levels and estimated glomerular filtration rate were measured pre and 6-weeks post-infusion. All patients were followed up until 6 weeks to assess the control of their asthma.

Results: All 20 patients completed the study. No patient experienced acute hypersensitivity or infusion reactions. At 6 weeks follow-up, no patient reported worsening of their asthma. There was an increase in mean haemoglobin from 10.1 to 11.1 g/dl and mean ferritin from 93.5 to 302.6 ng/ml.

Conclusions: This study demonstrates that IV CosmoFer may be administered safely in asthmatics by administering a single 50 mg dose of hydrocortisone pre-infusion.