Iron overdose: A contributor to adverse outcomes in randomized trials of anemia correction in CKD

Peter Van Buren, Ruben L. Velez, Nosratola D. Vaziri, Xin J. Zhou

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Administration of intravenous iron to supplement erythropoiesis stimulating agents (ESAs) has become a common practice in the management of anemia in patients with end-stage renal disease. Randomized clinical trials of anemia correction in this population have shown more adverse outcomes in CKD and ESRD patients assigned to the higher hemoglobin targets. Retrospective analysis of these trials suggests that morbidity is higher in subjects who fail to achieve the designated hemoglobin target and are typically exposed to higher doses of ESAs and iron than those that easily achieve the intended targets. Intravenous iron administration circumvents the natural biologic mechanisms for handling and utilization of iron. There is in vitro and in vivo evidence that intravenous iron preparations can cause oxidative stress, endothelial dysfunction, inflammation, impaired immunity, and renal injury. Since iron overload is known to promote endothelial dysfunction, cardiovascular disease, and immune dysfunction which are the leading causes of premature mortality in CKD and ESRD patients, it is imperative to exercise caution with the use of IV iron preparations in this population. The present review is intended to provide a brief overview of the potential adverse effects of the overzealous use of these agents.

Original languageEnglish (US)
Pages (from-to)499-507
Number of pages9
JournalInternational Urology and Nephrology
Volume44
Issue number2
DOIs
StatePublished - Apr 2012

Fingerprint

Anemia
Iron
Hematinics
Chronic Kidney Failure
Intravenous Administration
Hemoglobins
Premature Mortality
Iron Overload
Practice Management
Population
Immunity
Oxidative Stress
Cardiovascular Diseases
Randomized Controlled Trials
Exercise
Inflammation
Morbidity
Kidney
Wounds and Injuries

Keywords

  • Anemia
  • Chronic kidney disease
  • End-stage renal disease
  • Hemodialysis
  • Iron

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Iron overdose : A contributor to adverse outcomes in randomized trials of anemia correction in CKD. / Van Buren, Peter; Velez, Ruben L.; Vaziri, Nosratola D.; Zhou, Xin J.

In: International Urology and Nephrology, Vol. 44, No. 2, 04.2012, p. 499-507.

Research output: Contribution to journalArticle

Van Buren, Peter ; Velez, Ruben L. ; Vaziri, Nosratola D. ; Zhou, Xin J. / Iron overdose : A contributor to adverse outcomes in randomized trials of anemia correction in CKD. In: International Urology and Nephrology. 2012 ; Vol. 44, No. 2. pp. 499-507.
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