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Iron in Chronic Kidney Disease and End-Stage Kidney Disease-Current Trends and Future Direction

Thomas McDonnell1,2, Philip A Kalra1,2

  • 1Donal O'Donoghue Renal Research Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.

British Journal of Hospital Medicine (London, England : 2005)
|February 25, 2025
PubMed

Insights

Anemia is a common complication in chronic kidney disease (CKD). Iron deficiency, both absolute and functional, significantly impacts CKD anemia, necessitating a review of intravenous iron therapies.

Area of Science:

  • Nephrology
  • Hematology

Background:

  • Anemia is a frequent complication in chronic kidney disease (CKD), impacting both non-dialysis-dependent (NDD) and dialysis-dependent (DD) patients.
  • Erythropoietin (EPO) deficiency is a primary cause, but iron deficiency (ID) is also crucial.
  • ID in CKD presents as absolute (blood loss) or functional (inflammation, elevated hepcidin), hindering erythropoiesis and oral iron absorption.

Purpose of the Study:

  • To review current intravenous (IV) iron formulations for CKD anemia.
  • To discuss diagnostic criteria and treatment thresholds for ID in NDD and DD CKD patients.
  • To explore future therapeutic strategies for managing iron deficiency in CKD.

Main Methods:

  • Literature review of available intravenous iron formulations.
  • Analysis of diagnostic definitions and treatment thresholds for iron deficiency in CKD.
  • Exploration of emerging therapeutic directions for iron management in CKD.

Main Results:

  • Intravenous iron formulations offer an alternative when oral iron is ineffective, particularly in advanced CKD.
  • Clear diagnostic definitions and treatment thresholds are essential for effective ID management.
  • Functional iron deficiency, driven by inflammation and hepcidin, poses unique challenges.

Conclusions:

  • Intravenous iron is vital for managing anemia in CKD patients with iron deficiency.
  • Optimizing diagnosis and treatment thresholds for ID is critical for improving patient outcomes.
  • Further research into novel therapeutic approaches is needed to address the complexities of iron metabolism in CKD.

Keywords:
chronic kidney diseasefunctional iron deficiencyhepcidinhypoxia-inducible factor prolyl hydroxylase inhibitorsintravenous ironiron deficiencyoral iron

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