title: The Labile Side of Iron Supplementation in CKD.
abstract: The practice of intravenous iron supplementation has grown as nephrologists have gradually moved away from the liberal use of erythropoiesis-stimulating agents as the main treatment for the anemia of CKD. This approach, together with the introduction of large-dose iron preparations, raises the future specter of inadvertent iatrogenic iron toxicity. Concerns have been raised in original studies and reviews about cardiac complications and severe infections that result from long-term intravenous iron supplementation. Regarding the iron preparations specifically, even though all the currently available preparations appear to be relatively safe in the short term, little is known regarding their long-term safety. In this review we summarize current knowledge of iron metabolism with an emphasis on the sources and potentially harmful effects of labile iron, highlight the approaches to identifying labile iron in pharmaceutical preparations and body fluids and its potential toxic role as a pathogenic factor in the complications of CKD, and propose methods for its early detection in at-risk patients.
authors.affiliation: Division of Adult Nephrology, Shaare Zedek Medical Center and Hadassah Hebrew University of Jerusalem, Jerusalem, Israel; and islotki@szmc.org.il.
authors.forename: Itzchak
authors.initials: I
authors.lastname: Slotki
authors.affiliation: Department of Biological Chemistry, Alexander Silberman Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
authors.forename: Zvi Ioav
authors.initials: ZI
authors.lastname: Cabantchik
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D018798:Anemia, Iron-Deficiency / Q000150:complications* / Q000188:drug therapy; D000818:Animals; D002986:Clinical Trials as Topic; D019587:Dietary Supplements; D006397:Hematinics / Q000008:administration & dosage; D006801:Humans; D007249:Inflammation; D007501:Iron / Q000008:administration & dosage* / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008264:Macrophages / Q000378:metabolism; D018384:Oxidative Stress; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors
chemical_list: D006397:Hematinics; D007501:Iron
keywords: anemia; chronic renal disease; inflammation; labile iron; mortality risk