Considerations and challenges in defining optimal iron utilization in hemodialysis - PubMed (original) (raw)

Review

. 2015 Jun;26(6):1238-47.

doi: 10.1681/ASN.2014090922. Epub 2014 Dec 26.

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Review

Considerations and challenges in defining optimal iron utilization in hemodialysis

David M Charytan et al. J Am Soc Nephrol. 2015 Jun.

Abstract

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.

Keywords: ESRD; anemia; dialysis; erythropoietin.

Copyright © 2015 by the American Society of Nephrology.

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Figures

Figure 1.

Figure 1.

Trends in mean serum ferritin over time. Data sources include the ESRD Core Indicators Project, the USRDS, the Dialysis Outcomes Practices Patterns Study, the Network 11 ELab Project, and the Medicare Clinical Performance Measure Reports.,,, IV, intravenous.

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