Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years. The safety of various iron compounds has been of theoretical concern due to their potential to induce iron overload, oxidative stress, hypersensitivity reactions, and a permissive environment for infectious processes. Therefore, an expert group was convened to assess the benefits and risks of parenteral iron, and to provide strategies for its optimal use while mitigating the risk for acute reactions and other adverse effects.
Bibliographical noteFunding Information:
ICM declared having received consultancy fees from AMAG, Pharmacosmos, Takeda and Vifor; speaker honoraria from Vifor; and research support from Vifor Fresenius Medical Care Renal Pharma. AJB declared having received speaker honoraria from Vifor. K-UE declared having received consultancy fees from Amgen, Johnson & Johnson, Sandoz-Hexal, and Vifor and speaker honoraria from Amgen and Roche. GTO declared having received consultancy fees from Abbvie and Amgen and speaker honoraria from Abbott Nutrition, Abbvie, and Amgen. CAP declared having received consultancy fees from Amgen Australia, Astra Zeneca, Boehringer Ingelheim, Janssen Cilag, and Merck Sharp & Dohme; speaker honoraria from Astra Zeneca, Janssen Cilag, and Merck Sharpe & Dohme; and research support from Australian Research Council, Diabetes Australia, Hillcrest Foundation and JDRF. PS declared having received consultancy fees from Abbvie, Amgen, Keryx, Pfizer, and Vifor and speaker honoraria from Asahi, Bayer, and Keryx. DWS declared having received research support from EUROCALIN (EUROpean Consortium for AntiCALINS) and applied for research funding from the Dutch Kidney Foundation. As an employee of Radboud University Medical Center, DWS is also affiliated with its Hepcidinanalysis.com initiative, which offers hepcidin measurements to the scientific, commercial, and clinical community on a fee-for-service basis. CW declared having received consultancy fees from Boehringer Ingelheim and Genzyme; speaker honoraria from Abbvie, Amgen, Boehringer Ingelheim, CorMedix, Genzyme, Merck Sharp & Dohme, Pfizer, and Sanofi; and research support from Genzyme. GW declared having received speaker honoraria from Pharmacosmos and Vifor. GMC declared having received consultancy fees from AMAG and research support from Amgen (personally received 1% from grant support). The conference was sponsored by KDIGO and supported in part by unrestricted educational grants from Akebia Therapeutics, Amgen, Bayer HealthCare, F. Hoffmann-La Roche Ltd., FibroGen, Keryx Biopharmaceuticals, Rockwell Medical, Pharmacosmos, and Vifor Fresenius Medical Care.
- chronic kidney disease
- oxidative stress