title: Safety Issues in Iron Treatment in CKD.
abstract: Intravenous iron products are essential for the treatment of anemia in end-stage renal disease patients maintained on hemodialysis. Although proper use of these compounds is necessary for the prevention of iron deficiency, their indiscriminate use could potentially cause insidious adverse consequences. Iron overload can intensify the chronic kidney disease-associated oxidative stress, inflammation, and cardiovascular disease; increase the risk of infections; worsen the severity of type 2 diabetes; and exacerbate neurologic and cognitive dysfunction. These and other adverse effects largely are mediated by iron-catalyzed generation of reactive oxygen species. Unlike conventional oral iron products, the newly released iron-containing phosphate binder ferric citrate has been shown to increase iron stores in end-stage renal disease patients. Therefore, iron indices should be monitored in patients receiving this product. Two published studies have shown a high prevalence of hepatic iron loading among hemodialysis patients treated with erythropoiesis-stimulating agents and intravenous iron compounds. Given the potential risks related to iron treatment in this vulnerable population, studies to better understand safety are needed.
authors.affiliation: Division of Nephrology and Hypertension, Departments of Medicine and Physiology and Biophysics, University of California Irvine, Orange, CA. Electronic address: ndvaziri@uci.edu.
authors.forename: Nosratola D
authors.initials: ND
authors.lastname: Vaziri
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D060825:Cognitive Dysfunction / Q000139:chemically induced / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000378:metabolism; D018450:Disease Progression; D005290:Ferric Compounds / Q000009:adverse effects; D006397:Hematinics / Q000009:adverse effects*; D006801:Humans; D058085:Iron Compounds / Q000009:adverse effects*; D019190:Iron Overload / Q000139:chemically induced*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D018384:Oxidative Stress; D017382:Reactive Oxygen Species; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism*
chemical_list: D005290:Ferric Compounds; D006397:Hematinics; D058085:Iron Compounds; D017382:Reactive Oxygen Species; C025314:ferric citrate
keywords: Anemia; cardiovascular disease; infection; inflammation; neurologic disorders; oxidative stress; progression of kidney disease