Summary: There is great interest in the development of compounds better tolerated than iron salts; numerous compounds have been proposed (eg, sucrosomial iron, heme iron polypeptide, iron containing nanoparticles), but studies are limited. Sucrosomial iron has been tested in patients with CKD, but the mechanism of absorption and the real benefits are uncertain. In the same condition, the phosphate binder iron ferric citrate simultaneously corrects both hyperphosphatemia and iron deficiency; its double effect is being tested in a clinical trial in CKD. A phase 3 trial of ferric maltol provided positive results on iron deficiency anemia in inflammatory bowel diseases. Rigorously designed clinical trials are needed to confirm the efficacy of these iron preparations.
Summary: Intravenous (IV) iron is indicated as a source of iron replacement in iron deficiency anemia if the patient cannot tolerate oral iron, has malabsorption syndrome or an inflammatory process, and a need to rapidly replete iron stores. IV iron is also recommended in patients receiving ESAs.
Summary: Anemia of cancer and treatment is very common. Anemia of cancer leads to poor quality of life, unnecessary exposure to transfusion risk and may cause delay in treatment. IV iron and ESA are infrequently used due to the safety concerns. IV iron alone or given before ESA may help correct the anemia of malignancy and treatment. A SABM Literature Review and Recommendations of this specific therapeutic area is also available.
Summary: Anemia is common in CKD and may be managed with iron alone or in conjunction with ESA. Left untreated, anemia has adverse effects on cardiac function, QOL, CKD progression and survival.
Summary: Iron deficiency and iron deficiency anemia may affect a significant proportion of individuals with inflammatory bowel disease (IBD) and those who have undergone bariatric surgery. IV iron is preferred for the following reasons: 1) Many individuals with IBD have severe intolerance to oral iron preparations, which may also worsen IBD disease activity. 2) Individuals with IBD may have ongoing inflammation and/or malabsorption that may interfere with iron absorption, and IV iron is better able than oral iron to partially overcome the iron-restricted erythropoiesis associated with inflammation.
Summary: Iron deficiency with or without anemia, has a prevalence that may exceed 30-40% and is underrecognized and undertreated. Iron deficiency has a negative impact on quality of life, increased morbidity and mortality, and an association with poor fetal outcomes. Its early recognition and treatment is a global issue and should be a high priority.