The Labile Side of Iron Supplementation in CKD

Area of Science:

• Nephrology
• Hematology
• Pharmacology

Background:

• Shift from erythropoiesis-stimulating agents to intravenous iron for managing anemia of chronic kidney disease (CKD).
• Increased use of high-dose intravenous iron preparations raises concerns about potential iatrogenic iron toxicity.
• Existing knowledge on the long-term safety of current intravenous iron preparations is limited.

Purpose of the Study:

• To review current understanding of iron metabolism, focusing on labile iron.
• To identify sources and harmful effects of labile iron in CKD.
• To propose methods for early detection of labile iron in at-risk patients.

Main Methods:

• Literature review of iron metabolism and intravenous iron supplementation in CKD.
• Analysis of studies and reviews concerning cardiac complications and infections linked to intravenous iron.
• Examination of methods for identifying labile iron in pharmaceutical preparations and biological fluids.

Main Results:

• Labile iron, a potentially toxic form, may contribute to CKD complications.
• Current intravenous iron preparations show short-term safety but long-term effects are largely unknown.
• Potential for inadvertent iron toxicity due to increased use of intravenous iron.

Conclusions:

• Long-term safety of intravenous iron supplementation in CKD requires further investigation.
• Understanding and monitoring labile iron is crucial for preventing iron toxicity in CKD patients.
• Development of early detection methods for labile iron is needed to mitigate risks.