Iron treatment: impact of safety issues

Improved outcomes result when a hemodialysis patient's hematocrit is increased to greater then 33%. The recent National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) Anemia Panel recommended the use of intravenous (i.v.) iron therapy to increase hematocrits into this range. As the use of i.v. iron has increased, there has been an interest in more critically assessing the potential risks of such therapy. In this article, the possible risks are reviewed and considered in concert with the known benefits of iron treatment. A recommendation is made, in contrast to the NKF-DOQI Guidelines, that i.v. iron should not be administered to hemodialysis patients if the serum ferritin level if greater than 500 ng/mL.