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Pediatric Nephrology

, Volume 22, Issue 4, pp 480–489

First Online: 06 January 2007Received: 06 July 2006Revised: 13 November 2006Accepted: 14 November 2006


Iron deficiency is the most common cause of hyporesponsiveness to erythropoiesis-stimulating agents ESAs in end-stage renal disease ESRD patients. Iron deficiency can easily be corrected by intravenous iron administration, which is more effective than oral iron supplementation, at least in adult patients with chronic kidney disease CKD. Iron status can be monitored by different parameters such as ferritin, transferrin saturation, percentage of hypochromic red blood cells, and-or the reticulocyte hemoglobin content, but an increased erythropoietic response to iron supplementation is the most widely accepted reference standard of iron-deficient erythropoiesis. Parenteral iron therapy is not without acute and chronic adverse events. While provocative animal and in vitro studies suggest induction of inflammation, oxidative stress, and kidney damage by available parenteral iron preparations, several recent clinical studies showed the opposite effects as long as intravenous iron was adequately dosed. Thus, within the recommended international guidelines, parenteral iron administration is safe. Intravenous iron therapy should be withheld during acute infection but not during inflammation. The integration of ESA and intravenous iron therapy into anemia management allowed attainment of target hemoglobin values in the majority of pediatric and adult CKD and ESRD patients.

KeywordsIron supplementation Iron status Inflammation Infection Erythropoiesis-stimulating agents  Download fulltext PDF

Autor: Walter H. Hörl


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