Resolving the paradigm crisis in intravenous iron and erythropoietin management.
Despite the proven benefits of intravenous (i.v.) iron therapy in anemia management, it remains underutilized in the hemodialysis population. Although overall i.v. iron usage continues to increase slowly, monthly usage statistics compiled by the US Renal Data System suggest that clinicians are not implementing continued dosing regimens following repletion of iron stores. Continued therapy with i.v. iron represents a key opportunity to improve patient outcomes and increase the efficiency of anemia treatment. Regular administration of low doses of i.v. iron prevents the recurrence of iron deficiency, enhances response to recombinant human erythropoietin therapy, minimizes fluctuation of hemoglobin levels, hematocrit levels, and iron stores, and may reduce overall costs of care. This article reviews the importance of i.v. iron dosing on a regular basis in the hemodialysis patient with iron-deficiency anemia and explores reasons why some clinicians may still be reluctant to employ these protocols in the hemodialysis setting.
Besarab
A
A
Henry Ford Hospital, 2799 West Grand Blvd, CFP511, Detroit, Michigan 48202, USA. abesarab@ghsrenal.com
D018798:Anemia, Iron-Deficiency / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004920:Erythropoiesis / Q000502:physiology; D004921:Erythropoietin / Q000009:adverse effects* / Q000627:therapeutic use*; D005290:Ferric Compounds / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood; D007275:Injections, Intravenous; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects* / Q000639:trends; D018570:Risk Assessment; D016896:Treatment Outcome
D005290:Ferric Compounds; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron; C035552:ferric gluconate