Experience With Intravenous Iron in Nephrology

Over the last two decades, the use of intravenous iron in nephrology practice has increased considerably. This is due to several factors: first, there has been increased recognition of the benefits of intravenous iron in the management of renal anemia; second, the advent of erythropoiesis-stimulating agent (ESA) therapy has increased the demand for intravenous iron supplementation; and third, the older dextran-containing iron preparations have been replaced by newer intravenous iron compounds that are safer and not associated with life-threatening anaphylaxis. Intravenous iron can potentiate the response to ESA therapy and allow a reduction in ESA dose requirements, and in some patients it may improve hemoglobin levels when administered alone. Safety concerns such as increased risk of exacerbating infections or oxidative stress are largely based on in vitro data, and clinical data to support these concerns are sparse. Intravenous iron may be administered as a slow bolus injection or as an infusion, and there is a need for further studies to elucidate which, if any, of these regimens should be recommended.