Journal
KIDNEY INTERNATIONAL
Volume 89, Issue 1, Pages 28-39Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.kint.2015.10.002
Keywords
chronic kidney disease; hypersensitivity; infections; iron; overload; oxidative stress
Categories
Funding
- AMAG
- Pharmacosmos
- Takeda
- Vifor
- Vifor Fresenius Medical Care Renal Pharma
- Amgen
- Johnson Johnson
- Sandoz-Hexal
- Abbvie
- Amgen Australia
- Astra Zeneca
- Boehringer Ingelheim
- Janssen Cilag
- Merck Sharp Dohme
- Australian Research Council
- Diabetes Australia
- Hillcrest Foundation
- JDRF
- Keryx
- Pfizer
- EUROCALIN (EUROpean Consortium for AntiCALINS)
- Dutch Kidney Foundation
- Genzyme
- KDIGO
- Akebia Therapeutics
- Bayer Health Care
- F. Hoffmann-La Roche Ltd.
- FibroGen
- Keryx Biopharmaceuticals
- Rockwell Medical
- Vifor Fresenius Medical Care
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Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years. The safety of various iron compounds has been of theoretical concern due to their potential to induce iron overload, oxidative stress, hypersensitivity reactions, and a permissive environment for infectious processes. Therefore, an expert group was convened to assess the benefits and risks of parenteral iron, and to provide strategies for its optimal use while mitigating the risk for acute reactions and other adverse effects.
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