Considerations and challenges in defining optimal iron utilization in hemodialysis

Area of Science:

• Nephrology
• Hematology
• Pharmacology

Background:

• Erythropoiesis-stimulating agent (ESA) concerns and practice changes have driven increased intravenous iron use in dialysis patients.
• This has resulted in significantly elevated serum ferritin concentrations, exceeding 800 ng/ml on average in US dialysis patients by 2013.
• The long-term safety and efficacy of this widespread practice remain uncertain.

Purpose of the Study:

• To examine the influences on and trends in intravenous iron utilization in maintenance dialysis patients.
• To assess the existing evidence regarding the safety and efficacy of parenteral iron therapy in this population.

Main Methods:

• Review of clinical trial data.
• Analysis of epidemiologic evidence.
• Evaluation of experimental studies on intravenous iron in dialysis.

Main Results:

• Current data suggest a potential for harm associated with increased parenteral iron use in dialysis-dependent patients.
• Evidence indicates a rise in iron utilization and serum ferritin levels.

Conclusions:

• Available evidence is insufficient to draw reliable conclusions on mortality or other outcomes due to a lack of well-powered randomized clinical trials.
• Nephrology stakeholders must prioritize well-designed studies to ensure patient safety regarding intravenous iron therapy.