[Recommendations of iron management in chronic kidney patients]

The national and international recommendations concerning the iron management in chronic kidney disease (CKD) patient are well established. All acknowledge the fact that iron needs are increased in uremic patients. This is particularly true for CKD-5 patients treated by hemodialysis (increased losses) and when treated by an erythropoetic stimulating agent (ESA). Annual iron requirements are currently estimated between 500 mg and 3000 mg per year. The biodisponibility of oral iron isreduced and side effects are quite common. The venous supplementation of iron offers today the best safety/efficacy profile. The evaluation of iron store is mandatory in CKD patient. The assessment of iron store in kidney patient relies on three major markers: transferrin saturation (Trf Sat); ferritin; percentage of hypochromic erythroid cells. Faced to iron deficiency, it is crucial to differentiate two situations: an absolute iron deficiency (Trf Sat < 20 % ; ferritin < 100 ng/ml; percentage of hypochromic cells > 10%); a functional iron deficiency (Trf Sat < 20%; ferritin > 200-500 ng/ml; percentage of hypochromic cells > 5-10%). When intravenous iron supplementation is indicated, dosing regime should be based on a slow and a reduced dosage administration to comply with manufacturer and best practice recommendations. Regular iron infusion of 50 to 100 mg per week is able to cover the basic needs for most hemodialysis patients.