Clinical Aspects of Iron Use in the Anemia of Kidney Disease

Hörl, Walter H.

doi:10.1681/asn.2006080856

Cited by 129 publications

(98 citation statements)

References 123 publications

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“…However, the use of ESAs to normalize hemoglobin levels has repeatedly been shown to be associated with an increased risk of cardiovascular events and death 2, 3, 4, 5. The use of iron with ESAs is prerequisite for optimal management of anemia in patients with CKD 6. Intravenous (IV) iron therapy reduces ESA requirements and increases hemoglobin levels 7…”

Section: Introductionmentioning

confidence: 99%

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

Kuo

Hung

Tseng

et al. 2018

JAHA

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BackgroundThe Taiwan Health Insurance Bureau has conducted a bundled payment system for hemodialysis reimbursement since 1995. The maximum dose of erythropoiesis‐stimulating agents allowed by insurance is capped at 20 000 U of epoetin or 100 μg of darbepoetin alfa per month. Nephrologists have avoided the use of high dosages of erythropoiesis‐stimulating agents to achieve a hemoglobin level of 10 to 11 g/dL by iron supplementation. The clinical impact of these policies on patients’ outcomes is unknown. The authors aimed to assess the AIM‐HD (Association of Anemia, Iron parameters, and Mortality among the prevalent Hemodialysis patients) Study in Taiwan.Methods and ResultsThe AIM‐HD study was conducted based on the Taiwan Renal Registry Data System. From 2001 to 2008, the authors enrolled 42 230 patients undergoing hemodialysis who were older than 20 years and had received hemodialysis for more than 12 months. Patient follow‐ups occurred until death or December 31, 2008. During a study period of 8 years, 12 653 (30.0%) patients died. After multivariate adjustment, the authors found that a hemoglobin level <10 g/dL was significantly associated with higher risk for all‐cause and cardiovascular deaths. Moreover, a serum ferritin level between 300 and 800 ng/mL and transferrin saturation value between 30% and 50% were associated with the lowest all‐cause mortality.ConclusionsThe authors recommend avoiding a low hemoglobin level and maintaining serum ferritin between 300 and 800 ng/mL and transferrin saturation between 30% and 50%, which were associated with lower risks of all‐cause mortality among patients undergoing hemodialysis receiving the restricted erythropoiesis‐stimulating agent doses but prompt intravenous iron supplementation in Taiwan.

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Section: Introductionmentioning

confidence: 99%

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

Kuo

Hung

Tseng

et al. 2018

JAHA

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“…The main factors that contribute to iron deficiency in patients with ESRD are reduced intake and impaired intestinal absorption of dietary iron, blood losses, and/or increased iron requirements during therapy with erythropoiesis-stimulating agents. 12 The dialysis patients are in a state of continuous iron loss from gastrointestinal bleeding, blood drawing, and/or, most important with hemodialysis, the dialysis treatment itself. Hemodialysis patients lose an average of 2 g of iron per year.…”

Section: Discussionmentioning

confidence: 99%

Safety Issues With Intravenous Iron Products in the Management of Anemia in Chronic Kidney Disease

Hayat¹

2008

Clinical Medicine & Research

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“…18 The effective use of oral iron therapy may be limited in patients with CKD due to insufficient intestinal absorption and gastrointestinal complaints that may reduce patient compliance with treatment. 22 Three of the four published randomized controlled trials that examined the efficacy of treatment with IV and oral iron in anemic, ND-CKD patients indicated that IV iron was more efficacious than oral iron, 23,24,25 whereas a fourth showed no added benefit from IV iron. 26 Taken together, these studies A n estimated 26 million adults in the United States have chronic kidney disease (CKD).…”

Section: Methods: This Was a Retrospective Cohort Analysis Using 2006mentioning

confidence: 99%

Clinical and Economic Outcomes in Medicare Beneficiaries with Stage 3 or Stage 4 Chronic Kidney Disease and Anemia: The Role of Intravenous Iron Therapy

Knight

Ryan²,

Schaefer³

et al. 2010

JMCP

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• Anemia is a common occurrence in patients with chronic kidney disease (CKD), with reported prevalence rates of 9%-64% depending on CKD stage and definition of anemia and is associated with increased morbidity and mortality. In a sample of patients with incident CKD, Thorp et al. (2009) [IV]) in CKD patients with anemia (defined as hematocrit less than 33% in women of childbearing age or less than 37% in men and postmenopausal women) in whom therapy with an erythropoiesisstimulating agent (ESA) does not raise the hematocrit above the threshold levels because iron levels are too low. Iron deficiency is defined in the NIDDK guidelines as a ferritin score less than 100 micrograms (mcg) per liter and a transferrin saturation (TSAT) score less than 20%.• While previous research has demonstrated the effectiveness of IV iron therapy in correcting anemia in some patients with CKD, the clinical and economic outcomes associated with IV iron therapy compared with other treatments including ESA in routine clinical practice are unknown. What is already known about this subjectABSTRACT BACKGROUND: Anemia in patients with chronic kidney disease (CKD) is associated with increased morbidity and mortality, decreased quality of life, and substantial health care costs. Iron therapy is recommended, usually in combination with an erythropoiesis-stimulating agent (ESA), in many CKD patients with anemia and low iron levels to raise hemoglobin levels to a range of 10 to 12 grams per deciliter; iron deficiency is defined by a ferritin score less than 100 micrograms (mcg) per liter and transferrin saturation (TSAT) less than 20%.

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Clinical Aspects of Iron Use in the Anemia of Kidney Disease

Cited by 129 publications

References 123 publications

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

Safety Issues With Intravenous Iron Products in the Management of Anemia in Chronic Kidney Disease

Clinical and Economic Outcomes in Medicare Beneficiaries with Stage 3 or Stage 4 Chronic Kidney Disease and Anemia: The Role of Intravenous Iron Therapy

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