Bone Marrow Iron, Iron Indices, and the Response to Intravenous Iron in Patients With Non–Dialysis-Dependent CKD

Sica, Simona; Stanciu, Ana; Zugravu, Adrian; Bârsan, Liliana; Dumitru, Daniela; Lipan, Mariana; Mircescu, Gabriel

doi:10.1053/j.ajkd.2009.10.043

Cited by 82 publications

(71 citation statements)

References 34 publications

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“…One report showed that 48% of predialysis CKD patients with anemia who were not receiving ESA or iron had iron deficiency in the bone marrow, and 18% had iron overload [102]. Moreover, 60-70% of the patients with GFR levels <60 mL/min had serum ferritin levels <100 ng/ mL and TSAT <20%, indicating the possibility that the number of patients with iron deficiency increases as CKD progresses [103].…”

Section: )mentioning

confidence: 99%

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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Section: )mentioning

confidence: 99%

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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“…1,2 Anemia is associated with mortality and cardiovascular events, decrements in physical health and quality of life, and the need for blood transfusion. 3 The treatment of anemia in NDD-CKD has been challenged of late due to evolving concerns regarding the safety of erythropoiesis stimulating agents (ESAs), 4 heightening interest in an "iron first" approach, as recommended by clinical practice guidelines.…”

mentioning

confidence: 99%

“…6 Epidemiologic and bone marrow biopsy studies have estimated the prevalence of iron deficiency in NDD-CKD at 48%-98%. 2,7,8 Conventional (over-the-counter) iron preparations have demonstrated mixed efficacy in NDD-CKD 9 along with frequent adverse gastrointestinal effects. Despite a relatively high prevalence of anemia, relatively few patients with stages 4-5 CKD are treated with intravenous (IV) iron, 10 owing to associated risks including anaphylactoid reactions, concerns regarding the need for multiple venous cannulations in patients who may require creation of arteriovenous fistula for hemodialysis, and a variety of logistic hurdles.…”

mentioning

confidence: 99%

Effects of Ferric Citrate in Patients with Nondialysis-Dependent CKD and Iron Deficiency Anemia

Fishbane

Block

Loram

et al. 2017

JASN

131

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Iron deficiency anemia is common and consequential in nondialysis-dependent CKD (NDD-CKD). Efficacy and tolerability of conventional oral iron supplements are mixed; intravenous iron administration associates with finite but important risks. We conducted a randomized double-blind clinical trial in adults with NDD-CKD and iron deficiency anemia to compare the safety and efficacy of oral ferric citrate (n=117) and placebo (n=115). The primary end point was the proportion of patients who achieved a $1.0 g/dl increase in hemoglobin at any time during a 16-week randomized period. Patients who completed the 16-week period could also participate in an 8-week open-label extension period. Significantly more patients randomized to ferric citrate achieved the primary end point (61 [52.1%] versus 22 [19.1%] with placebo; P,0.001). All secondary end points reached statistical significance in the ferric citrate group, including the mean relative change in hemoglobin (0.84 g/dl; 95% confidence interval, 0.58 to 1.10 g/dl; P,0.001) and the proportion of patients who achieved a sustained increase in hemoglobin ($0.75 g/dl over any 4-week period during the randomized trial; 57 [48.7%] versus 17 [14.8%] with placebo; P,0.001). Rates of serious adverse events were similar in the ferric citrate (12.0%) and placebo groups (11.2%). Gastrointestinal disorders were the most common adverse events, with diarrhea reported in 24 (20.5%) and 19 (16.4%) and constipation in 22 (18.8%) and 15 (12.9%) patients treated with ferric citrate and placebo, respectively. Overall, in patients with NDD-CKD, we found oral ferric citrate to be a safe and efficacious treatment for iron deficiency anemia.

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“…Iron deficiency is another common cause of anemia in these patients and is a major cause of hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) [3]. Approximately, 50% of patients with CKD, who have anemia and are not receiving ESA or iron supplementation show depleted iron stores in their bone marrow [4]. Although the use of intravenous iron in hemodialysis patients has significantly increased during the last decade [5], the appropriate iron dosing strategy in CKD remains debatable.…”

Section: Editorialmentioning

confidence: 99%

Use of Iron Therapy in Chronic Kidney Disease

Rottembourg¹

2016

Arch Clin Nephrol

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Bone Marrow Iron, Iron Indices, and the Response to Intravenous Iron in Patients With Non–Dialysis-Dependent CKD

Cited by 82 publications

References 34 publications

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Effects of Ferric Citrate in Patients with Nondialysis-Dependent CKD and Iron Deficiency Anemia

Use of Iron Therapy in Chronic Kidney Disease

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