[Issues related to iron replacement in dialyzed patients]

Correction of renal anaemia by erythropoiesis stimulating agents (ESA) had reduced blood transfusion needs and iron overload risk and nowadays most of end-stage renal disease patients treated with dialysis requires i.v. iron supplementation to optimize the action of ESAs. Recommended targets for iron therapy are serum ferritin > 100 microg/l and hypochromic red cells percentage (HRC) < 10 (or transferrin saturation coefficient [TSAT] > 20% or reticulocyte Hb content [CHr] > 29 pg/cell). If i.v. administration is strongly recommended for all dialysis patients, controversies remain for the mode and rhythm of administration. Follow-up should be done every 1 to 3 months with measurement of serum ferritin in order to keep its level < 500 to 800 microg/l. Potential toxicity of chronic exposure to i.v. iron concerns tissue accumulation, consequences of pro-oxidant effects, cardiovascular damage and increased risk of infection but no clinical data unequivocally confirm that iron overload from parenteral iron contributes to all cause morbidity and mortality. In conclusion, i.v. iron should be used to optimize ESA action and could be used safety if dosage is < or = 100 mg/week and serum ferritin < 500 a 800 microg/l.