We Give Too Much Intravenous Iron.

Area of Science:

• Nephrology
• Hematology
• Pharmacology

Background:

• Dialysis patients frequently experience iron deficiency, impacting erythropoiesis.
• Oral iron is often insufficient for maintaining iron stores in dialysis patients, especially with erythropoiesis-stimulating agent use.
• Intravenous (IV) iron protocols are common but raise safety concerns.

Purpose of the Study:

• To review the current landscape of iron management in dialysis patients.
• To discuss the risks and benefits of IV iron therapy.
• To explore emerging oral and dialysate iron strategies.

Main Methods:

• Review of current literature on iron deficiency in dialysis.
• Analysis of IV iron protocols and associated risks.
• Evaluation of recent studies on novel oral and dialysate iron preparations.

Main Results:

• IV iron use has increased, leading to higher ferritin levels but persistent safety questions.
• Oral ferric citrate and soluble ferric pyrophosphate in dialysate show promise in maintaining iron stores and hemoglobin.
• Concerns regarding IV iron's link to infection, cardiac, and hepatobiliary risks persist.

Conclusions:

• The limitations of oral iron and risks of IV iron necessitate alternative strategies.
• Newer oral and dialysate iron formulations offer potential to improve iron management in dialysis patients.
• These advancements may decrease reliance on IV iron and mitigate associated risks.