title: Iron dosing in kidney disease: inconsistency of evidence and clinical practice.
abstract: The management of anemia in patients with chronic kidney disease (CKD) is difficult. The availability of erythropoiesis-stimulating agents (ESAs) has increased treatment options for previously transfusion-requiring patients, but the recent evidence of ESA side effects has prompted the search for complementary or alternative approaches. Next to ESA, parenteral iron supplementation is the second main form of anemia treatment. However, as of now, no systematic approach has been proposed to balance the concurrent administration of both agents according to individual patient's needs. Furthermore, the potential risks of excessive iron dosing remain a topic of controversy. How, when and whether to monitor CKD patients for potential iron overload remain to be elucidated. This review addresses the question of risk and benefit of iron administration in CKD, highlights the evidence supporting current practice, provides an overview of standard and potential new markers of iron status and outlines a new pharmacometric approach to physiologically compatible individualized dosing of ESA and iron in CKD patients.
authors.affiliation: University of Louisville, Louisville KY, USA.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Gaweda
authors.affiliation: New York Blood Center, New York, NY, USA.
authors.forename: Yelena Z
authors.initials: YZ
authors.lastname: Ginzburg
authors.affiliation: University of Massachusetts, Amherst, MA, USA.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Chait
authors.affiliation: Baystate Medical Center, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Germain
authors.affiliation: University of Louisville, Louisville KY, USA.
authors.forename: George R
authors.initials: GR
authors.lastname: Aronoff
authors.affiliation: The Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Rachmilewitz
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology; D004921:Erythropoietin / Q000008:administration & dosage*; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D058085:Iron Compounds / Q000008:administration & dosage*; D019190:Iron Overload / Q000517:prevention & control; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D006397:Hematinics; D058085:Iron Compounds; D004921:Erythropoietin
keywords: anemia; erythropoiesis; iron; iron deficiency; iron overload; kidney disease