title: Iron Treatment Strategies in Dialysis-Dependent CKD.
abstract: Iron deficiency is common in patients on chronic dialysis, and most require iron-replacement therapy. In addition to absolute iron deficiency, many patients have functional iron deficiency as shown by a suboptimal response to the use of erythropoietin-stimulating agents. Both absolute and functional iron-deficiency anemia have been shown to respond to intravenous (IV) iron replacement. Although parenteral iron is an efficacious method and superior to standard doses of oral iron in patients on hemodialysis, there are ongoing safety concerns about repeated exposure potentially enhancing infection risk and cardiovascular disease. Each IV iron product is composed of an iron core with a carbohydrate shell. The avidity of iron binding and the type of carbohydrate shell play roles in the safe maximal dose and the frequency and severity of acute infusion reactions. All IV iron products are taken up into the reticuloendothelial system where the shell is metabolized and the iron is stored within tissue ferritin or exported to circulating transferrin. IV iron can be given as large intermittent doses (loading therapy) or in smaller doses at frequent intervals (maintenance dosing regimen). Limited trial data and observational data suggest that a maintenance dosing regimen is more efficacious and possibly safer than loading therapy. There is no consensus regarding the preferred method of iron repletion in patients on peritoneal dialysis, although small studies comparing oral and parenteral iron regimens in these patients have shown the latter to be more efficacious. Use of IV iron in virtually all hemodialysis and many peritoneal dialysis patients remains the standard of care.
authors.affiliation: Washington University, St. Louis, MO.
authors.forename: Richa
authors.initials: R
authors.lastname: Pandey
authors.affiliation: Washington University, St. Louis, MO.
authors.forename: Reem
authors.initials: R
authors.lastname: Daloul
authors.affiliation: Washington University, St. Louis, MO. Electronic address: DCoyne@dom.wustl.edu.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Coyne
mesh_terms: D061605:Administration, Intravenous; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D004187:Disaccharides / Q000627:therapeutic use; D005290:Ferric Compounds / Q000627:therapeutic use; D000077605:Ferric Oxide, Saccharated; D005293:Ferritins / Q000378:metabolism; D052203:Ferrosoferric Oxide / Q000627:therapeutic use; D005937:Glucaric Acid / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use*; D007505:Iron-Dextran Complex / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D008320:Maltose / Q000031:analogs & derivatives / Q000627:therapeutic use; D006435:Renal Dialysis; D014168:Transferrin / Q000378:metabolism
chemical_list: D004187:Disaccharides; D005290:Ferric Compounds; D006397:Hematinics; D006454:Hemoglobins; D058085:Iron Compounds; D014168:Transferrin; C557707:iron isomaltoside 1000; C522335:ferric carboxymaltose; D008320:Maltose; D007505:Iron-Dextran Complex; D005293:Ferritins; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid; C035552:ferric gluconate; D052203:Ferrosoferric Oxide
keywords: •