Treating iron deficiency and iron deficiency anaemia in patients with CKD
In patients with CKD-associated iron deficiency anaemia, the aim of iron therapy is to ensure adequate iron stores for erythropoiesis, to correct iron deficiency, and, in patients receiving ESA treatment, to prevent iron deficiency from developing. Iron therapy, particularly with IV iron, can enhance erythropoiesis and raise haemoglobin levels in CKD patients with anaemia even when TSAT and ferritin levels do not indicate absolute iron deficiency1.
Initiating iron therapy in CKD patients
The KDIGO guidelines and recommendations state that iron therapy be trialled in CKD patients based on haemoglobin, TSAT and ferritin levels in the context of ESA therapy (see table below)1,2.
Table 3. Criteria for initiating iron therapy in patients with chronic kidney disease1,2
IV versus oral iron treatment in CKD patients
Iron can be administered orally or by intravenous (IV) injection. For patients with dialysis-dependent CKD, supplementation with IV iron is recommended1,3. For non-dialysis dependent patients1, the decision to initiate IV or oral iron therapy is dependent on a number of different factors; however, studies consistently show that IV iron provides significantly greater improvements in haemoglobin levels either in the presence or absence of ESAs (see table below)3.
Table 4. Factors for consideration in choosing between IV or oral iron therapy1
Oral iron does offer some advantages in terms of convenience and lack of immunogenic properties; the risk of anaphylaxis has been of concern with traditional, high-molecular-weight iron dextran IV formulations. However, newer products, such as iron sucrose, low-molecular-weight iron dextrans and ferrous gluconate, have a much lower risk of anaphylaxis4.
Once iron therapy is initiated, the decision to continue treatment should be based on patients’:
- Current haemoglobin levels
- Haemoglobin responses to recent iron therapy
- Any recent blood losses
- Iron status tests (TSAT and ferritin)
- ESA responsiveness and dose in ESA treated patients
- Clinical status
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