Managing Iron Deficiency Anemia of CKD With IV Iron
Managing Iron Deficiency Anemia of CKD With IV Iron
ADEs, drug interactions, and lack of adherence limit the use of oral iron therapy. For HD-dependent patients, who often have limited absorption of oral iron, IV supplementation is preferred. The 2006 and 2007 updates to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines for anemia of CKD recommend that HD patients on ESA therapy receive IV iron supplementation to maintain a target Hgb of 11 g/dL to 12 g/dL (not to exceed 13 g/dL). The guidelines also recommend that non–dialysis-dependent and peritoneal dialysis–dependent patients receive iron either orally or IV.
Iron repletion should begin before initiation of ESA therapy. Iron levels should initially be monitored monthly until iron stores are replenished, then monitored quarterly. Smaller maintenance doses may be necessary after repletion, because Hgb optimization can occur in patients whose ferritin is >500 ng/mL. Overall clinical status, degree of ESA responsiveness, and other causes of increased ferritin (infection, inflammation) should be considered. Data are lacking regarding cessation of IV iron therapy. An increase in Hgb >1 g/dL over 1 month indicates a therapeutic response to iron therapy when IDA diagnosis in complex situations is unclear. Monitoring of iron levels also is important to avoid iron overload or toxicity and to prevent hemochromatosis from developing.
Iron Supplementation
ADEs, drug interactions, and lack of adherence limit the use of oral iron therapy. For HD-dependent patients, who often have limited absorption of oral iron, IV supplementation is preferred. The 2006 and 2007 updates to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines for anemia of CKD recommend that HD patients on ESA therapy receive IV iron supplementation to maintain a target Hgb of 11 g/dL to 12 g/dL (not to exceed 13 g/dL). The guidelines also recommend that non–dialysis-dependent and peritoneal dialysis–dependent patients receive iron either orally or IV.
Iron repletion should begin before initiation of ESA therapy. Iron levels should initially be monitored monthly until iron stores are replenished, then monitored quarterly. Smaller maintenance doses may be necessary after repletion, because Hgb optimization can occur in patients whose ferritin is >500 ng/mL. Overall clinical status, degree of ESA responsiveness, and other causes of increased ferritin (infection, inflammation) should be considered. Data are lacking regarding cessation of IV iron therapy. An increase in Hgb >1 g/dL over 1 month indicates a therapeutic response to iron therapy when IDA diagnosis in complex situations is unclear. Monitoring of iron levels also is important to avoid iron overload or toxicity and to prevent hemochromatosis from developing.
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