Clinical aspects of iron use in the anemia of kidney disease.

I ron deficiency occurs in the vast majority of patients with chronic kidney disease (CKD). The causes of iron deficiency in these patients are multifactorial. Main factors that contribute to iron deficiency in patients with end-stage renal disease (ESRD) are reduced intake and impaired intestinal absorption of dietary iron, blood losses, chronic inflammation associated with ESRD and/or increased iron requirements during therapy with erythropoiesis-stimulating agents (ESA). Anemia is a common complication of CKD that can be corrected by ESA. Failure to achieve adequate iron stores and availability is the main cause of hyporesponsiveness to ESA therapy (1,2). The use of iron in combination with ESA is required for optimal management of the anemia of CKD. Management of iron status in patients with CKD involves excluding iron deficiency, providing adequate iron stores to allow patients to maintain target hemoglobin levels efficiently, and avoiding iron overload.