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Iron Deficiency in CKD Without Concomitant Anemia
Jay B Wish1, Stefan D Anker2,3,4, Javed Butler5
1Division of Nephrology, Indiana University Health, Indianapolis, Indiana, USA.
Kidney International Reports
|November 22, 2021
Summary
Iron deficiency (ID) in chronic kidney disease (CKD) is distinct from anemia and warrants treatment regardless of hemoglobin levels. Addressing ID alone may improve outcomes in CKD patients, similar to heart failure patients.
Area of Science:
- Nephrology
- Cardiology
- Hematology
Background:
- Iron's physiological role extends beyond red blood cell production.
- Iron deficiency (ID) and anemia in chronic kidney disease (CKD) are distinct but interrelated.
- Current CKD management prioritizes anemia correction over iron repletion.
Purpose of the Study:
- Differentiate iron deficiency from anemia in CKD.
- Review evidence linking iron repletion to outcomes in heart failure (HF) and CKD.
- Explore potential benefits of iron therapy in CKD irrespective of anemia.
Main Methods:
- Epidemiological and pathophysiological analysis of ID and anemia in CKD.
- Review of clinical studies on iron therapy in heart failure with reduced ejection fraction (HFrEF).
- Examination of evidence for iron therapy in CKD patients with or without anemia.
Main Results:
- Iron deficiency is a distinct clinical entity from anemia in CKD.
- Iron repletion improves outcomes in HFrEF patients.
- Evidence suggests potential benefits of iron therapy in CKD independent of anemia.
Conclusions:
- Iron deficiency management in CKD requires re-evaluation beyond anemia correction.
- Further research is needed to establish optimal iron therapy strategies in CKD.
- Clinicians should consider iron status in CKD management, especially in patients with HF comorbidities.
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