Iron Deficiency Anemia in Chronic Kidney Disease.
Study Goal
The researchers aimed to review the evidence for iron supplementation recommendations in CKD patients, focusing on distinguishing between absolute and functional iron deficiency and evaluating treatment approaches.
Results Summary
The study found that iron supplementation is recommended for CKD patients with anemia, with intravenous iron preferred for dialysis patients and either intravenous or oral iron for non-dialysis CKD patients. Iron deficiency in CKD is defined by specific TSAT and ferritin thresholds, and anemia in CKD is linked to increased morbidity and mortality.
Population
Chronic kidney disease (CKD) patients, including predialysis, peritoneal dialysis, and hemodialysis patients.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
iron supplementation | decrease | anemia | all CKD patients with anemia | - | is recommended | #1 |
intravenous (i.v.) iron supplementation | neutral | - | CKD patients on dialysis (CKD stage 5D) | - | is the preferred method | #2 |
intravenous (i.v.) or oral iron | neutral | - | patients with CKD ND (CKD stages 3-5) | - | is recommended | #3 |
Iron deficiency anemia is a common complication of chronic kidney disease (CKD). CKD patients suffer from both absolute and functional iron deficiency. Absolute iron deficiency is defined by severely reduced or absent iron stores, while functional iron deficiency is defined by adequate iron stores but insufficient iron availability for incorporation into erythroid precursors. This is due to increased levels of hepcidin. Anemia in CKD is associated with an increased risk of morbidity and mortality. The association between anemia and mortality may be related to the severity of anemia. All CKD patients should be screened for anemia during the initial evaluation for CKD. Criteria used to define iron deficiency are different among CKD compared to normal renal function. Among CKD patients, absolute iron deficiency is defined when the transferrin saturation (TSAT) is ≤20% and the serum ferritin concentration is ≤100 ng/mL among predialysis and peritoneal dialysis patients or ≤200 ng/mL among hemodialysis patients. Functional iron deficiency, also known as iron-restricted erythropoiesis, is characterized by TSAT ≤20% and elevated ferritin levels. Iron supplementation is recommended for all CKD patients with anemia. There is general agreement according to guidelines that intravenous (i.v.) iron supplementation is the preferred method for CKD patients on dialysis (CKD stage 5D) and either i.v. or oral iron is recommended for patients with CKD ND (CKD stages 3-5). In this review we discuss the evidence base for these recommendations.