title: [Therapy of anemia and iron deficiency in dialysis patients: an update].
abstract: The Kidney Disease Improving Global Outcomes (KDIGO)-2012 on the treatment of anemia emit suggestions (which differ from recommendations) based on a scientific evidence of low level. The first rule is no harm; physicians must take into account the profile of the patient and its associated morbidities and remember on the potential risks to begin a treatment by erythropoiesis stimulating agents (ESA) (thrombosis of arteriovenous fistula, hypertension, stroke). All correctable causes of anemia other than erythropoietin deficiency should be actively sought. It is necessary to individualize the treatment by ESA and assess the clinical improvement expected. The ESA will be used in the following way: initiate at 10 g/dL of hemoglobin level with the aim of 11.5 g/dL, without exceeding 13 g/dL. In case of ESA resistance, it seems suitable to assess the risks and benefits of ESA versus blood transfusion. The ERBP-2013 have endorsed the KDIGO-2012 except the proposals dealing with the treatment by IV iron. The use of intravenous iron must be more cautious in the future taking into account the results of a recent French study published in the American Journal of Medicine showing the high frequency of iron overload at quantitative hepatic MRI among haemodialysis patients receiving iron IV following the current guidelines. It is appropriate to use oral iron in first intention as recommended by the ANSM (French Drug Agency) in a recent information note and respect the dosage regimen of the label. The realization of a quantitative hepatic MRI to evaluate iron overload and monitor the treatment by iron IV must also be considered on a case by case basis.
authors: Service de néphrologie et de dialyse, hôpital privé Claude-Galien, générale de santé, 20, route de Boussy-Saint-Antoine, 91480 Quincy-sous-Sénart, France. Electronic address: rostotom@orange.fr.
authors: Guy
authors: G
authors: Rostoker
authors: Service de néphrologie et de dialyse adultes, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France.
authors: Aurélie
authors: A
authors: Hummel
authors: Service de néphrologie et de dialyse, centre hospitalier de Mulhouse, 20, avenue du docteur René-Laënnec, 68100 Mulhouse, France.
authors: François
authors: F
authors: Chantrel
authors: Service de néphrologie-dialyse-transplantation rénale, CHU Clémenceau, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors: Jean-Philippe
authors: JP
authors: Ryckelynck
mesh_terms: D000740:Anemia / Q000209:etiology / Q000628:therapy*; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D019190:Iron Overload / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*
chemical_list: D006397:Hematinics; D058085:Iron Compounds
keywords: Agents stimulants l’érythropoïèse (ASE); ERBP; ESA; Fer intraveineux; Hemosiderosis; Hémosidérose; IV iron; Imagerie par résonance magnétique (IRM); KDIGO; MRI