This study examplifies the importance of head-to-head comparisons for determining the relative safety of two intravenous iron preparations. Ferumoxytol was given in 30-60 seconds, which was probably responsible for the small number of hypotensive episodes observed. In the first 90 administrations of this formulation in our practice, we observed 3 such episodes. Subsequently we slowed the administration to 90 seconds and have observed no hypotensive episodes in >1000 doses. Consistent with our observations and those of the recently published manuscript by Macdougall et al. (Clin J Am Soc Nephrol 2014;9:705-12), this formulation appears to be equal in safety and efficacy to not iron sucrose, but also to low-molecular-weight iron dextran and ferric carboxymaltose, although no head-to-head comparisons are available the latter two formulations.

– Michael Auerbach

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