Safety of intravenous iron in clinical practice: implications for anemia management protocols.

Optimizing anemia management is the sole indication for intravenous (IV) iron administration in the patient with chronic kidney disease (CKD): Achieving and maintaining iron sufficiency is crucial to achieving and maintaining target-range hemoglobin (Hgb). Although pica (geophagia) (1) and restless legs syndrome (2,3) may arise in iron-deficient patients, available reports on the efficacy of IV iron therapy for long-term management of nonhematologic manifestations of iron deficiency are inconclusive. These narrow therapeutic indications constrain tolerance for potential adverse effects of IV iron in CKD patients. To be judged safe, IV iron therapy must show hematologic benefit (increase in Hgb, decrease in erythropoietin (ESP) dose, or both) without risking an increase in mortality or morbidity.