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Iron overdose: a contributor to adverse outcomes in randomized trials of anemia correction in CKD

Peter Van Buren1, Ruben L Velez, Nosratola D Vaziri

  • 1Departments of Internal Medicine/Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

International Urology and Nephrology
|July 12, 2011
PubMed

Insights

Intravenous iron, used with erythropoiesis-stimulating agents for anemia in end-stage renal disease, may increase risks. Caution is advised due to potential adverse effects like oxidative stress and inflammation.

Area of Science:

  • Nephrology
  • Hematology
  • Pharmacology

Background:

  • Intravenous iron is commonly used with erythropoiesis-stimulating agents (ESAs) for anemia in end-stage renal disease (ESRD).
  • Higher hemoglobin targets in clinical trials for chronic kidney disease (CKD) and ESRD patients have been linked to adverse outcomes.
  • Retrospective analyses suggest increased morbidity in patients failing to reach hemoglobin targets, often requiring higher ESA and iron doses.

Purpose of the Study:

  • To review potential adverse effects of intravenous (IV) iron administration in patients with CKD and ESRD.
  • To highlight the risks associated with overzealous use of IV iron in managing anemia.

Main Methods:

  • Review of randomized clinical trials and retrospective analyses concerning anemia management in CKD/ESRD.
  • Examination of in vitro and in vivo evidence on the biological effects of IV iron preparations.

Main Results:

  • IV iron bypasses natural iron regulation, potentially causing oxidative stress, endothelial dysfunction, inflammation, impaired immunity, and renal injury.
  • Iron overload is associated with endothelial dysfunction, cardiovascular disease, and immune dysfunction, major causes of mortality in CKD/ESRD.

Conclusions:

  • Caution is imperative when using IV iron preparations in CKD and ESRD patients.
  • The potential for adverse effects necessitates careful consideration of IV iron administration, especially at high doses or when targets are not met.

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