title: Iron management in chronic kidney disease: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference.
abstract: Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years. The safety of various iron compounds has been of theoretical concern due to their potential to induce iron overload, oxidative stress, hypersensitivity reactions, and a permissive environment for infectious processes. Therefore, an expert group was convened to assess the benefits and risks of parenteral iron, and to provide strategies for its optimal use while mitigating the risk for acute reactions and other adverse effects.
authors.affiliation: Department of Renal Medicine, King's College Hospital, London, UK. Electronic address: iain.macdougall@nhs.net.
authors.forename: Iain C
authors.initials: IC
authors.lastname: Macdougall
authors.affiliation: Allergy Unit, Dermatology Clinic, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Bircher
authors.affiliation: Department of Nephrology and Hypertension, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.affiliation: Universidad Panamericana School of Medicine, Mexico City, Mexico.
authors.forename: Gregorio T
authors.initials: GT
authors.lastname: Obrador
authors.affiliation: University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Pollock
authors.affiliation: Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.affiliation: Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Dorine W
authors.initials: DW
authors.lastname: Swinkels
authors.affiliation: Renal Division, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.affiliation: Department of Internal Medicine VI, Infectious Disease, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Günter
authors.initials: G
authors.lastname: Weiss
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D064451:Hepcidins / Q000097:blood; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D007239:Infections / Q000097:blood; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D000090463:Iron Deficiencies; D019190:Iron Overload / Q000097:blood / Q000139:chemically induced; D018384:Oxidative Stress; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D064451:Hepcidins; D005293:Ferritins; D007501:Iron
keywords: chronic kidney disease; hypersensitivity; infections; iron; overload; oxidative stress