New aspects of iron therapy in patients with renal insufficiency

Absolute or functional iron deficiency is a common problem in renal insuffi ciency, which may lead to iron-deficient erythropoiesis and then contribute s to renal anemia. Lack of available iron is the most common reason for unr esponsiveness to epoetin in patients on chronic dialysis. Assessing and opt imizing iron stores is therefore essential for effective therapy of anemia in patients with renal insufficiency. Measurements of serum ferritin, trans ferrin saturation and percentage of hypochromic red blood cells allow the a ssessment of iron status. Several iron preparations are available for intra venous substitution, especially the newly registered iron-saccharose offers safe and reliable iron supplementation and reduces the risk of anaphylaxis and iron toxicity in patients with renal insufficiency. This review shows the literature and discusses new guidelines concerning diagnosis of iron st atus, indication for therapy, target levels and iron preparation in patient s with anemia of chronic renal failure.