Iron, EPO Anemia and Kidney Disease

Iron Anemia and kidney disease

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Spiegel and Chertow in the Clinical Journal of the American Society of Nephrology have taken a look at the direction we are heading in the treatment of anemia in ESRD based on a few recent studies.

Their commentary is particularly interesting because it brings to light a new possible threat, the injudicious use of iron in the absence of sufficient safety data.

They highlight several clinical controversies still facing patients in the dialysis population. Controversies that stem from recently done studies which have questioned the optimal hemoglobin range for correction of anemia and the absence of any long term safety data for IV iron therapy.

It is suggested that economic factors may further complicate the use of such agents based on the reimbursement model, the drive for profit in dialysis providers and marketing pressures from big Pharma.

Several unanswered questions remain that are likely to be further muddled before the situation becomes more clear. What is the best marker of an adequate iron load? Serum ferritin has been shown to be a poor marker. It is well established that serum ferritin is a better marker of overall inflammation than of iron stores in patients on dialysis. If the administration of iron to patients with high serum ferritin is thought to produce a benefit in terms of reduction of ESA dosage, then economic pressure to see the administration of iron in patients with high serum ferritin may cause the adoption of protocols that have a limited safety track record. The interplay of iron, ESA and reimbursement policy is something to watch for in upcoming industry news.