TY - JOUR
T1 - A Comprehensive Vision for Intravenous Iron Therapy
AU - Coyne, Daniel W.
N1 - Funding Information:
Financial Disclosure: Within the past 3 years, Dr Coyne reports having served as a consultant for AMAG Pharmaceuticals Inc, which is developing an IV iron replacement therapeutic for the treatment of iron deficiency anemia in patients with CKD; Watson Pharmaceuticals, which markets an injectable sodium ferric gluconate compound; and Roche, which markets an ESA. He has served as a speaker for Watson and Amgen Inc, which markets an ESA. Within this period, Dr Coyne has also received research funding from AMAG Pharmaceuticals Inc, Amgen Inc, Roche, and Watson Pharmaceuticals.
PY - 2008/12
Y1 - 2008/12
N2 - Commonly used iron indices, such as serum ferritin and transferrin saturation (TSAT), have limited utility in patients with chronic kidney disease. Both dialysis and nondialysis patients may have normal to high serum ferritin levels and little or no iron available for erythropoiesis. Inflammation can result in increased serum ferritin level and low TSAT and restrict the ability to mobilize iron stores. Management of anemia in patients with chronic kidney disease requires recognizing that not only decreased erythropoietin production, but also decreased iron availability, can lead to anemia. The Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) trial showed the efficacy of intravenous (IV) iron in anemic hemodialysis patients with serum ferritin levels of 500 to 1,200 ng/mL and TSAT of 25% or less receiving adequate erythropoiesis-stimulating agent doses. Withholding iron from these patients resulted in worsening iron-restricted erythropoiesis. To improve anemia management in patients receiving hemodialysis and being treated with ESAs, clinicians should consider the benefits of IV iron.
AB - Commonly used iron indices, such as serum ferritin and transferrin saturation (TSAT), have limited utility in patients with chronic kidney disease. Both dialysis and nondialysis patients may have normal to high serum ferritin levels and little or no iron available for erythropoiesis. Inflammation can result in increased serum ferritin level and low TSAT and restrict the ability to mobilize iron stores. Management of anemia in patients with chronic kidney disease requires recognizing that not only decreased erythropoietin production, but also decreased iron availability, can lead to anemia. The Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) trial showed the efficacy of intravenous (IV) iron in anemic hemodialysis patients with serum ferritin levels of 500 to 1,200 ng/mL and TSAT of 25% or less receiving adequate erythropoiesis-stimulating agent doses. Withholding iron from these patients resulted in worsening iron-restricted erythropoiesis. To improve anemia management in patients receiving hemodialysis and being treated with ESAs, clinicians should consider the benefits of IV iron.
KW - Intravenous iron
KW - anemia of chronic kidney disease
KW - erythropoiesis-stimulating agent
KW - serum ferritin
UR - http://www.scopus.com/inward/record.url?scp=55749098626&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2008.09.003
DO - 10.1053/j.ajkd.2008.09.003
M3 - Review article
C2 - 19010257
AN - SCOPUS:55749098626
SN - 0272-6386
VL - 52
SP - S14-S20
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6 SUPPL. 1
ER -