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Iron supplementation to treat anemia in patients with chronic kidney disease

Anatole Besarab1, Daniel W Coyne

  • 1Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI 48301, USA.

Nature Reviews. Nephrology
|October 20, 2010
PubMed

Insights

Iron deficiency is common in chronic kidney disease (CKD). Intravenous iron is more effective than oral iron for managing anemia in hemodialysis patients, reducing the need for erythropoiesis-stimulating agents (ESAs).

Area of Science:

  • Nephrology
  • Hematology
  • Nutritional Science

Background:

  • Iron deficiency is a significant issue for patients with chronic kidney disease (CKD).
  • Anemia in CKD patients is often linked to iron deficiency, impacting treatment efficacy.
  • Erythropoiesis-stimulating agents (ESAs) are commonly used but their effectiveness can be limited by iron status.

Purpose of the Study:

  • To review the efficacy and safety of iron supplementation in treating anemia in CKD patients.
  • To compare oral versus intravenous iron administration in CKD populations.
  • To discuss the role of iron in patients undergoing dialysis versus those not requiring dialysis.

Main Methods:

  • Review of existing literature on iron supplementation in chronic kidney disease.
  • Analysis of studies comparing oral and intravenous iron formulations.
  • Examination of iron metabolism and hepcidin levels in CKD patients.

Main Results:

  • Intravenous iron is superior to oral iron in hemodialysis patients, improving hemoglobin levels and reducing ESA requirements.
  • Elevated hepcidin levels in CKD patients impair oral iron absorption and iron recycling.
  • Specific ferritin and transferrin saturation levels indicate iron deficiency, but high values lack diagnostic utility in dialysis patients.

Conclusions:

  • Iron supplementation is crucial for managing anemia in CKD patients.
  • Intravenous iron administration is preferred for hemodialysis patients due to absorption issues with oral iron.
  • Advances in iron delivery methods should improve iron provision for CKD patients.

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