In the Medical Letter article on Ferumoxytol (Feraheme) - A New Parenteral Iron Formulation (2010; 52:23), the last sentence of the Dosage, Administration and Cost paragraph should have listed the cost of 1 gram of sodium ferric gluconate (Ferrlecit) as about $600.

Ferumoxytol (Fer yoo mox’ i tole; Feraheme – AMAG), an intravenous (IV) iron replacement product, has been approved by the FDA for treatment of iron deficiency anemia in adults with chronic kidney disease. Iron deficiency anemia is common in chronic kidney disease and may be associated with decreased absorption from the gastrointestinal tract, limiting the usefulness of oral iron replacement. IV iron replacement can lower the dose requirement for erythropoiesis-stimulating drugs, particularly in patients on dialysis

Sevelamer carbonate (Renvela – Genzyme), a buffered form of the anion-exchange resin sevelamer hydrochloride (Renagel – Genzyme),1 has been approved by the FDA for use in patients with chronic kidney disease on dialysis. According to the manufacturer, Renvela will replace Renagel, which has been shown to induce or exacerbate metabolic acidosis in patients on dialysis. Two randomized, crossover studies found the two sevelamer salts equivalent in their ability to lower serum phosphate.2,3 Patients taking the carbonate had higher serum bicarbonate concentrations and fewer gastrointestinal adverse effects. Sevelamer carbonate, which is available in 800-mg tablets, can be substituted for the hydrochloride salt gram for gram. Recent studies in patients beginning hemodialysis have suggested a possible mortality benefit for sevelamer compared to less expensive calcium- based phosphate binders,4,5 but some critics are skeptical.6

1. Phosphate binders. Med Lett Drugs Ther 2006; 48:15.
2. J Delmez et al. A randomized, double-blind, crossover design study of sevelamer hydrochloride and sevelamer carbonate in patients on hemodialysis. Clin Nephrol 2007; 68:386.
3. S Fan et al. Renvela (sevelamer carbonate) powder and Renagel (sevelamer hydrochloride) tablets: report of a randomized, cross-over study in chronic kidney disease (CKD) patients on hemodialysis (poster). American Society of Nephrology Renal Week. October 31- November 5 2007. San Francisco.
4. GA Block et al. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007; 71:438.
5. AM Borzecki et al. Survival in end stage renal disease: calcium carbonate vs. sevelamer. J Clin Pharm Ther 2007; 32:617.
6. J Silver. The details bedevil DCOR. Kidney Int 2007; 72:1041.

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The erythropoiesis-stimulating agents (ESAs) epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp) are widely used for treatment of anemia and to reduce the need for red blood cell transfusions. Based on the results of recent clinical trials indicating an increased risk of serious adverse events and death associated with ESAs, particularly when used to achieve a hemoglobin concentration ≥12 g/dL, the FDA has revised the prescribing information for these drugs to include a black box warning.