Treatment of Iron Deficiency Anemia in CKD and End-Stage Kidney Disease

Abstract

Iron deficiency is common in individuals with chronic kidney disease and plays a major role in the development of anemia. Oral and intravenous iron agents are both available to replete iron in patients with chronic kidney disease diagnosed with iron deficiency. The choice of which agent to use is most often dictated by goals of therapy, tolerability, convenience, and response to prior therapy. Diminished absorption of iron in the gastrointestinal tract and a high incidence of gastrointestinal adverse effects can reduce the efficacy of oral iron agents, necessitating the use of i.v. iron formulations to treat iron deficiency anemia, particularly in patients requiring kidney replacement therapy. Newer oral agents may help to overcome these limitations and help treat iron deficiency in those not requiring kidney replacement therapy. Recent studies have provided new evidence that more aggressive repletion of iron in patients with chronic kidney disease requiring kidney replacement therapy may provide benefits with respect to anemia management and hard clinical outcomes such as cardiovascular disease and survival.

Serum Interleukin-6 is associated with hypocalcemia, hypoferritinemia and hyperkalemia in end-stage renal disease patients

“…r= -0.229, P= 0.049. There is a major perspective that inflammatory cytokines such as IL-6 play substantial role in hyperferritinemia that correlates to anemia of chronic diseases (7). This is thought to be mediated by hepcidin, a type II acute phase protein.…”

“…Patients with progressive renal failure experience significant mineral dysregulation. Overthrown mineral metabolism contributes to clinical symptoms, such as vascular calcification, bone demineralization, muscle atrophy, sexual impairment anemia and neuropathy( 6) and (7) .…”

Vascular calcification: Molecular mechanisms and therapeutic interventions

“…On one hand, iron deficiency causes anemia in CKD patients, the iron supplementation has already been prescribed to these patients. 132 , 279 Considering this, two oral formulations (iron citrate and sucroferric oxyhydroxide) have been approved for hyperphosphatemia treatment in CKD patients. 280 On the other hand, iron overload contributes to the process of endothelial cell calcification by inducing apoptosis and ferroptosis.…”

Iron deficiency anaemia: pathophysiology, assessment, practical management

“… 64 Despite the evidence provided for intravenous preparations, oral iron remains first-line therapy for many clinicians and patients as it is readily available, inexpensive and avoids the need for intravenous access, which can cause injury to blood vessels that may be needed in the future for critical vascular access. 65 Furthermore, there are concerns regarding potential side effects with intravenous iron including anaphylaxis, hypersensitivity, susceptibility to infections and cardiovascular events, hypophosphataemia and iron overload. 66 While human erythropoietin (EPO) and EPO-stimulating agents (ESA) have been in use for decades, they are associated with worsening hypertension, seizures and dialysis access clotting.…”