Renal function in patients with non-dialysis chronic kidney disease receiving intravenous ferric carboxymaltose: an analysis of the randomized FIND-CKD trial

Macdougall, Iain C.; Böck, Andreas; Carrera, Fernando; Eckardt, Kai‐Uwe; Gaillard, Carlo A. J. M.; Wyck, David Van; Meier, Yvonne; Larroque, Sylvain; Roger, Simon D.; Investigators, Find-Ckd Study

doi:10.1186/s12882-017-0444-6

Cited by 16 publications

(9 citation statements)

References 31 publications

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“…In addition, patients not responding to oral therapy are not given intravenous iron. Some experts believe that intravenous iron may reduce or delay the use of ESAs in ND-CKD patients [ 21 , 22 , 23 ]. KDIGO suggested treating ND-CKD patients with intravenous iron if they were still iron deficient after three months of oral therapy [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?

Aoun¹,

Karam²,

Sleilaty³

et al. 2018

PLoS ONE

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In non-dialysis chronic kidney disease patients, looking for iron deficiency is highly variable in practice and there is a great variability regarding the cutoffs used to treat iron deficiency. The aim of this study is to investigate the degree of iron deficiency in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents. We included all non-dialysis chronic kidney disease patients that applied to the Lebanese Ministry of Public Health for erythropoiesis-stimulating agents’ coverage during a 5-month period. Iron requirement was assessed based on two guidelines’ target-to-treat cutoffs: 1-ferritin <100 ng/ml and/or TSAT < 20% (KDOQI 2006), 2- ferritin ≤500 ng/ml and TSAT ≤30% (KDIGO 2012). A total of 238 CKD patients were included over 5 months. All patients had a ferritin level in their record and 64% had an available TSAT. Median age was 71.0 (59.8–79.3) years and 61.8% were female. All had an eGFR<60 ml/min. The proportion of patients found to require iron therapy ranged between 48 and 78% with a trend towards higher values when using KDIGO-based criteria. Using ANCOVA test, inverse normal transformations of ferritin and TSAT showed a reverse pattern between men and women with women being more iron deficient in the early stage. Iron deficiency is highly prevalent in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents’ therapy. These findings reflect a lack in effective iron supplementation when managing anemia in pre-dialysis patients, especially in men at advanced stages. Renal societies should spread awareness about iron deficiency screening in those patients.

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Section: Discussionmentioning

confidence: 99%

“…They found iron deficiency in ~98% of the patients and intravenous iron corrected patients’ hemoglogin levels [ 24 ]. It is noteworthy that the FIND-CKD trial has shown that intravenous iron targeting low or high ferritin levels has no adverse events on the CKD progression [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?

Aoun¹,

Karam²,

Sleilaty³

et al. 2018

PLoS ONE

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“…In contrast to REVOKE, FIND-CKD demonstrated no difference in the risk of infection, CV events, or kidney toxicity during 1 year of follow-up. 59 When interpreting these conflicting results, r several factors. 69,70 First, neither study was adequately powered to evaluate safety outcomes.…”

Section: Risks Of Iron Supplementation With Elevated Ferritinmentioning

confidence: 99%

Iron Deficiency in Chronic Kidney Disease: Updates on Pathophysiology, Diagnosis, and Treatment

Batchelor¹,

Kapitsinou

Pèrgola

et al. 2020

JASN

212

185

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Anemia is a complication that affects a majority of individuals with advanced CKD. Although relative deficiency of erythropoietin production is the major driver of anemia in CKD, iron deficiency stands out among the mechanisms contributing to the impaired erythropoiesis in the setting of reduced kidney function. Iron deficiency plays a significant role in anemia in CKD. This may be due to a true paucity of iron stores (absolute iron deficiency) or a relative (functional) deficiency which prevents the use of available iron stores. Several risk factors contribute to absolute and functional iron deficiency in CKD, including blood losses, impaired iron absorption, and chronic inflammation. The traditional biomarkers used for the diagnosis of iron-deficiency anemia (IDA) in patients with CKD have limitations, leading to persistent challenges in the detection and monitoring of IDA in these patients. Here, we review the pathophysiology and available diagnostic tests for IDA in CKD, we discuss the literature that has informed the current practice guidelines for the treatment of IDA in CKD, and we summarize the available oral and intravenous (IV) iron formulations for the treatment of IDA in CKD. Two important issues are addressed, including the potential risks of a more liberal approach to iron supplementation as well as the potential risks and benefits of IV versus oral iron supplementation in patients with CKD.

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“…There is extensive clinical trial evidence supporting the efficacy of IV iron preparations in patients with both non-dialysis-dependent and end-stage CKD [ 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ] and patients with CHF [ 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ], IBD [ 28 , 111 , 112 , 113 , 114 , 115 , 116 , …”

Section: Clinical Use Of IV Ironmentioning

confidence: 99%

Intravenous Irons: From Basic Science to Clinical Practice

et al. 2018

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Iron is an essential trace mineral necessary for life, and iron deficiency anaemia (IDA) is one of the most common haematological problems worldwide, affecting a sixth of the global population. Principally linked to poverty, malnutrition and infection in developing countries, in Western countries the pathophysiology of IDA is primarily linked to blood loss, malabsorption and chronic disease. Oral iron replacement therapy is a simple, inexpensive treatment, but is limited by gastrointestinal side effects that are not inconsequential to some patients and are of minimal efficacy in others. Third generation intravenous (IV) iron therapies allow rapid and complete replacement dosing without the toxicity issues inherent with older iron preparations. Their characteristic, strongly-bound iron-carbohydrate complexes exist as colloidal suspensions of iron oxide nanoparticles with a polynuclear Fe(III)-oxyhydroxide/oxide core surrounded by a carbohydrate ligand. The physicochemical differences between the IV irons include mineral composition, crystalline structure, conformation, size and molecular weight, but the most important difference is the carbohydrate ligand, which influences complex stability, iron release and immunogenicity, and which is a unique feature of each drug. Recent studies have highlighted different adverse event profiles associated with third-generation IV irons that reflect their different structures. The increasing clinical evidence base has allayed safety concerns linked to older IV irons and widened their clinical use. This review considers the properties of the different IV irons, and how differences might impact current and future clinical practice.

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Renal function in patients with non-dialysis chronic kidney disease receiving intravenous ferric carboxymaltose: an analysis of the randomized FIND-CKD trial

Abstract: Background: Preclinical studies demonstrate renal proximal tubular injury after administration of some intravenous iron preparations but clinical data on renal effects of intravenous iron are sparse.

Cited by 16 publications

References 31 publications

Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?

Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?

Iron Deficiency in Chronic Kidney Disease: Updates on Pathophysiology, Diagnosis, and Treatment

Intravenous Irons: From Basic Science to Clinical Practice

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