Considerations and challenges in defining optimal iron utilization in hemodialysis.

Charytan DM, Pai AB, Chan CT, Coyne DW, Hung AM, Kovesdy CP, Fishbane S, Dialysis Advisory Group of the American Society of Nephrology
J Am Soc Nephrol. 2015 26 (6): 1238-47

PMID: 25542967 · PMCID: PMC4446883 · DOI:10.1681/ASN.2014090922

Trials raising concerns about erythropoiesis-stimulating agents, revisions to their labeling, and changes to practice guidelines and dialysis payment systems have provided strong stimuli to decrease erythropoiesis-stimulating agent use and increase intravenous iron administration in recent years. These factors have been associated with a rise in iron utilization, particularly among hemodialysis patients, and an unprecedented increase in serum ferritin concentrations. The mean serum ferritin concentration among United States dialysis patients in 2013 exceeded 800 ng/ml, with 18% of patients exceeding 1200 ng/ml. Although these changes are broad based, the wisdom of these practices is uncertain. Herein, we examine influences on and trends in intravenous iron utilization and assess the clinical trial, epidemiologic, and experimental evidence relevant to its safety and efficacy in the setting of maintenance dialysis. These data suggest a potential for harm from increasing use of parenteral iron in dialysis-dependent patients. In the absence of well powered, randomized clinical trials, available evidence will remain inadequate for making reliable conclusions about the effect of a ubiquitous therapy on mortality or other outcomes of importance to dialysis patients. Nephrology stakeholders have an urgent obligation to initiate well designed investigations of intravenous iron in order to ensure the safety of the dialysis population.

Copyright © 2015 by the American Society of Nephrology.

MeSH Terms (18)

Anemia, Iron-Deficiency Animals Cross-Sectional Studies Disease Models, Animal Dose-Response Relationship, Drug Drug Administration Schedule Erythropoietin Ferritins Hematinics Humans Infusions, Intravenous Iron Compounds Kidney Failure, Chronic Prognosis Randomized Controlled Trials as Topic Renal Dialysis Risk Assessment Treatment Outcome

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