Understanding iron: promoting its safe use in patients with chronic kidney failure treated by hemodialysis

Although judicious use of intravenous iron preparations is an indispensable part of anemia treatment in hemodialysis patients, their excessive and indiscriminate use can have insidious but serious adverse consequences. With recent implementation of the bundling reimbursement policy, use of intravenous iron preparations in the hemodialysis population has markedly increased. Excessive use of these agents potentially can exacerbate oxidative stress, inflammation, endothelial dysfunction, cardiovascular disease, and immune deficiency and potentially increases the risk of microbial infections in this population. Most of these adverse effects are mediated by iron-catalyzed generation of reactive oxygen species and the resultant cell injury and dysfunction. This review is intended to provide an overview of the nature and mechanisms of the adverse effects of iron overload and call for the judicious use of these vitally important products.