Iron Deficiency in Kidney Disease
Anemia is a complication that affects a majority of individuals with advanced CKD [1]. Iron deficiency plays a significant role in anemia in CKD [1].
Many patients with anemia and CKD suffer from iron-deficiency anemia (IDA) [2,4]. This is due to both true paucity of iron stores (absolute IDA) and relative (functional) iron deficiency [1].
What is Kidney Disease?
Chronic Kidney Disease (CKD) means your kidneys are damaged and can’t filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time. This damage can cause wastes to build up in your body. CKD can also cause other health problems [6].
Do I have Iron Deficiency Anemia due to Kidney Disease?
Anemia, defined as a hemoglobin (Hgb) concentration of <13 g/ dl in men and <12 g/ dl in women, is an important complication of CKD [2].
What are the symptoms related to Kidney Disease?
Early CKD may not have any symptoms [6].
You may wonder how you can have CKD and feel fine. Our kidneys have a greater capacity to do their job than is needed to keep us healthy. For example, you can donate one kidney and remain healthy. You can also have kidney damage without any symptoms because, despite the damage, your kidneys are still doing enough work to keep you feeling well. For many people, the only way to know if you have kidney disease is to get your kidneys checked with blood and urine tests [6].
CDK is associated with Iron Deficiency Anemia?
Several risk factors contribute to absolute and functional iron deficiency in CKD, including blood losses, impaired iron absorption, and chronic inflammation [2].
Incidence and Prevalence
The prevalence of anemia increases across the advancing stages of CKD, with estimates anywhere from 7% to >50% in the more advanced stages of the disease [3].
Treatments
Oral agents include ferrus sulfate, ferrous gluconate, ferrous fumarate, iron polysaccharide, and ferric citrate (FC) [1]
Challenges of Iron Supplementation
It has been postulated that oxidative stress, induced by IV iron, may led to a higher risk of infection, atherosclerosis, and hospitalization [1].
Ferrus preparations tend to be used most frequently as they are less expensive and more widely available that other preparations [5], although their side effects limit the total daily dose tolerated. Additionally, there is evidence that IV iron may be more effective than oral iron in general [1].
- Batchelor EK, Kapitsinou P, Pergola PE, Kovesdy CP, Jalal DI. Iron Deficiency in Chronic Kidney Disease: Updates on Pathophysiology, Diagnosis, and Treatment. J Am Soc Nephrol. 2020 Mar;31(3):456-468. doi: 10.1681/ASN.2019020213. Epub 2020 Feb 10. PMID: 32041774; PMCID: PMC7062209. - https://pubmed.ncbi.nlm.nih.gov/32041774/
- Locatelli F, Nissenson AR, Barrett BJ, Walker RG, Wheeler DC, Eckardt KU, Lameire NH, Eknoyan G. Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2008 Nov;74(10):1237-40. doi: 10.1038/ki.2008.299. Epub 2008 Jul 2. PMID: 18596731. - https://pubmed.ncbi.nlm.nih.gov/18596731/
- Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014 Jan 2;9(1):e84943. doi: 10.1371/journal.pone.0084943. PMID: 24392162; PMCID: PMC3879360. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879360/
- Fishbane S, Pollack S, Feldman HI, Joffe MM. Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988-2004. Clin J Am Soc Nephrol. 2009 Jan;4(1):57-61. doi: 10.2215/CJN.01670408. Epub 2008 Nov 5. PMID: 18987297; PMCID: PMC2615715. - https://pubmed.ncbi.nlm.nih.gov/1898729
- Santiago P. Ferrous versus ferric oral iron formulations for the treatment of iron deficiency: a clinical overview. ScientificWorldJournal. 2012;2012:846824. doi: 10.1100/2012/846824. Epub 2012 May 2. PMID: 22654638; PMCID: PMC3354642. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354642/
- “What is chronic kidney disease?” National Institute of Diabetes and Digestive and Kidney Diseases, 26 July 2024, www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/what-is-chronic-kidney-disease.
Could you be experiencing iron deficiency?
