Iron deficiency is a major factor in the prevalence and severity of anemia in patients with chronic kidney disease (CKD). We review the pathophysiology impairing normal intestinal iron absorption in CKD and compare the characteristics of newer intravenous (i.v.) iron agents to the longstanding i.v. iron products in the market.
The newer iron products, ferumoxytol, ferric carboxymaltose, and iron isomaltoside, more avidly bind iron, minimizing the release of labile iron during infusions, thus permitting large dose infusions. These irons also have more complex carbohydrate shells than their predecessors, which may also diminish reactions. Newer agents can be routinely administered at higher single doses, in as little as 15 min, with an acceptable safety profile.
Newer i.v. iron products permit the rapid, and sometimes complete, repletion of iron-deficient patients with a single dose. However, further studies examining the long-term risks and benefits of i.v. iron repletion are needed.
Renal Division, Washington University, St. Louis, Missouri, USA
Correspondence to Daniel W. Coyne, MD, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8129, St. Louis, MO 63110, USA. Tel: +1 314 362 7211; fax: +1 314 747 3743; e-mail: DCoyne@dom.wustl.edu