Iron deficiency often occurs in patients with
chronic kidney disease and can be effectively treated with parenteral supplementation of
iron. In these patients, prompt application of
iron therapy can help to reduce the dependence of
erythropoietin-stimulating agents and effectively treat
anemia. Correct evaluation of
iron metabolism in CKD patients can be difficult. Duration of and response to
therapy should always be considered while planning parenteral supplementation of
iron. The main safety aspects of parenteral
iron preparations relate to their possible anaphylactic potential and the potential induction of oxidative stress due to the release of free
iron. However, parenteral
iron supplementation is usually safe and without major side effects. Regarding current data, none of the
iron preparations is showing definitive superiority. Although uncommon,
iron preparations containing
dextran can lead to severe side effects, therefore these preparations appear to have an inferior safety profile. Due to limited data, a comparison of third-generation
iron preparations with previous preparations is not possible. Recently, for the first time, the third generation
iron preparation
ferumoxytol has been directly compared to
iron sucrose. From this data and others, it remains unclear whether third generation
iron preparations show safety-relevant superiority.