Iron therapy in chronic kidney disease: Recent changes, benefits and risks.
Anemia is a common complication in patients with chronic kidney disease (CKD), mainly due to inadequate renal production of erythropoietin. In hemodialysis (HD) patients this condition may be aggravated by iron deficiency (absolute or functional). The correction of this anemia is usually achieved by treatment with erythropoiesis stimulating agents (ESAs) and iron (oral or intravenous). Studies questioning the safety of ESAs (especially at higher doses) changed the pattern of anemia treatment in CKD patients. According to the new guidelines, when transferrin saturation is lower than 30% and ferritin lower than 500 ng/mL, a trial with iron should be started, to avoid therapy with ESAs or at least to reduce the doses needed to treat the anemia. Recent reports showed increasing ferritin levels, towards values above 800 ng/mL, in CKD patients treated according to the guidelines. In this review we focus on the risks of the increased iron use to treat CKD anemia, namely, iron overload and toxicity, increased risk of infections, as well as mortality.
Research Unit on Applied Molecular Biosciences (UCIBIO), REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal. Electronic address: sandra.ribeiro870@gmail.com.
Sandra
S
Ribeiro
Research Unit on Applied Molecular Biosciences (UCIBIO), REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal. Electronic address: luisbelo@ff.up.pt.
Luís
L
Belo
Laboratory of Pharmacology & Experimental Therapeutics, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Unidade 1, Polo 3, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal; Center for Neuroscience and Cell Biology, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI) Research Unit, University of Coimbra, Polo 1, First floor, Rua Larga, 3004-504 Coimbra, Portugal. Electronic address: freis@fmed.uc.pt.
Flávio
F
Reis
Research Unit on Applied Molecular Biosciences (UCIBIO), REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal. Electronic address: assilva@ff.up.pt.
Alice
A
Santos-Silva
D018798:Anemia, Iron-Deficiency / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D054796:Drug Dosage Calculations; D000068817:Epoetin Alfa / Q000008:administration & dosage / Q000009:adverse effects*; D004921:Erythropoietin / Q000096:biosynthesis / Q000172:deficiency; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects*; D019190:Iron Overload / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D007668:Kidney / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D014168:Transferrin / Q000378:metabolism
D006397:Hematinics; D014168:Transferrin; D004921:Erythropoietin; D000068817:Epoetin Alfa; D005293:Ferritins; D007501:Iron
Anemia; Chronic kidney disease; Hemodialysis; Intravenous iron; Iron overload; Iron therapy; Mortality