Use of Iron Therapy in Chronic Kidney Disease

001 The use of iron is now a common practice in the treatment of anemia in CKD patients either oral or intravenous (IV), in spite of the concerns about the increase in ferritin levels and tissue iron overload due to the use of high/continuous iron supplementation, toxicity of different iron products, and the role of iron products in infection [11]. The decision for oral or IV iron treatment should balance the benefits and risks for the patient. Oral iron formulations are less expensive, and need high dosages (325 mg three times daily) to be effective; however at these dosages, the gastrointestinal side effects experienced by most of the patients may reduce the effect and adherence to treatment [12]. Some studies reported that IV therapy increases both Hb and ferritin, while oral iron therapy increases Hb without increasing substantially iron stores [13]. Moreover, most of the clinical studies evaluating oral and IV administration reported that IV iron therapy leads to a higher increase in Hb than oral iron therapy [14]. In some cases oral iron therapy is dedicated to non-dialysis CKD patients, but a recent trial shows some advantages to IV iron therapy in these patients [15]. In these patients the effects on kidney function remains unclear. A randomly trial was very recently published where CKD patients stage 3 and 4 and iron deficiency anemia were assigned either to oral iron or intravenous iron sucrose medications [16]. The primary outcome was the between-group difference in slope of measured glomerular filtration rate (mGFR) change over two years. The mGFR declined similarly over the study period in both treatment groups, but there were more cardiovascular events and more infections resulting in hospitalizations in the IV group resulting in an early termination of the study on the recommendation of an independent data and safety monitoring board [16]