Recent epidemiologic studies show that
iron deficiency occurs in the vast majority of patients with
chronic kidney disease (CKD). In patients with CKD, increased
iron losses and, to a lesser extent, poor oral absorption, can lead to
iron-deficiency anemia. Correction of
iron-deficiency anemia is preferable by the oral route, however, data on oral
iron use are limited in this population. In CKD patients, parenteral
iron administered with recombinant human
erythropoietin (rHuEpo), is the best potential option for the correction of
anemia. Nondextran
iron preparations are preferable because of a reduced incidence of serious adverse events. Parenteral
iron in CKD patients may not be entirely innocuous and, although commonly used, have not received Food and Drug Administration approval for use in this patient population. Exposure to intravenous (IV)
iron may lead to oxidative stress, renal injury,
infection, cardiovascular disease, and
osteomalacia. Studies are needed to confirm the existence and magnitude of these complications. The current data suggest that the overall risk-benefit ratio favors use of IV
iron when compared with untreated or partially treated
iron-deficiency anemia.