Intravenous iron for the treatment of predialysis anemia

This article, based on our own studies and those of others, presents eviden ce to show that the anemia of chronic renal failure in the predialysis peri od is, to a significant extent, caused by iron deficiency and can be improv ed in most cases by the administration of intravenous (i.v.) but not oral i ron. We estimate that in approximately 30% of all predialysis patients with anemia, a target hematocrit (Hct) of 35% can be reached and maintained by giving i.v. iron alone without exceeding currently acceptable limits of ser um ferritin (500 mu g/liter) or the percentage of iron saturation (40%). If , in addition, subcutaneous erythropoietin (EPO)-usually in only low doses- is added, the combination has an additive effect on the Hct response, and a lmost all anemic predialysis patients can reach and maintain the target Hct of 35% over a one-year period. Therefore, the advantage of maintaining ade quate iron stores with i.v. iron is that if EPO is needed, lower doses will be required to achieve the target Hct than if EPO were used alone. This no t only avoids the high cost of EPO therapy but also its associated side-eff ects, especially hypertension. Using Venofer, a ferric hydroxide sucrose co mplex, as our i.v. iron supplement, we have seen no anaphylactic reactions in over 20,000 infusions over a four-year period in 360 hemodialysis, lu pr edialysis, and 58 peritoneal dialysis patients.