Iron, Anemia, and You!

Introduction
Anemia is a major problem in people with chronic kidney disease. You need iron to help your body make healthy red blood cells (RBCs). Keeping anemia under control will help you feel your best.

What Is Anemia?

• RBCs in your blood carry oxygen to all parts of your body
• Anemia means not enough RBCs and, therefore, not enough oxygen for your body to function at its best
• Anemia may lead to:

  — Tiredness

  — Sensitivity to cold

  — Shortness of breath

  — Paleness

  — Dizziness or fainting

  — Loss of concentration

  — Chest pain

The Kidneys and Anemia

• Healthy kidneys help the body make enough RBCs by making a hormone called erythropoietin
• RBCs are formed in bone marrow with the help of this hormone, iron, certain vitamins, and protein

What Causes Anemia?

• Blood loss: if you lose blood, you lose RBCs and iron, too
• Not enough erythropoietin hormone: with chronic kidney disease, an outside source of erythropoietin may be needed
• Not enough iron: with chronic kidney disease, your body may need more iron than you get from food and oral iron supplements

Epogen^® (epoetin alfa), Procrit^® (epoetin alfa), and Aranesp^® (darbepoetin alfa)

• Man-made forms of the hormone erythropoietin
• Tells your body to make RBCs
• For these drugs to work best, you also need enough iron and certain vitamins

What Is Iron and Why Is It So Important?
Iron is an essential element in your RBCs. RBCs carry oxygen throughout your body. IRON—you need just the right amount!

Your doctor and healthcare team know when to give iron:

• Blood tests tell your doctor how healthy your RBCs are and if you have enough of them
• Blood tests show if you have enough iron to make healthy RBCs

Hemoglobin and Hematocrit

• Hemoglobin is the part of the RBC that contains oxygen. Hemoglobin should be between 11 and 12 g/dL in most CKD patients
• Hematocrit tells how many RBCs are in a specific amount of blood. Hematocrit should be between 33% and 36% in most CKD patients

Ferritin and Transferrin

• Ferritin shows the amount of iron in "storage." Ferritin should be between 100 and 800 ng/mL
• Transferrin shows the amount of iron "available" to make RBCs. Transferrin saturation should be between 20% and 50%

What Can Be Done to Prevent or Control Anemia?
Anemia is treated with:

• Epogen^®, Procrit^®, or Aranesp^® (man-made erythropoietin hormones)
• Iron (oral or intravenous)
• Vitamins
• Eating a protein-rich diet

Oral Iron
Your doctor may first prescribe oral iron. Oral iron is usually given 1 to 3 times a day between meals.

Please remember:

• Take oral iron 1 hour before or 2 hours after a meal
• Do not take with antacids
• Do not take with phosphate binders
• If you get constipated, ask your doctor about taking stool softeners

IV Iron
If you are not able to reach a good RBC count with oral iron, or if you cannot tolerate oral iron, your doctor may prescribe intravenous (IV) iron. IV iron is injected into your bloodstream.

The Food and Drug Administration has approved 3 types of IV iron products for use in the United States. These are:

• Iron sucrose injection, USP
• Iron dextran injection, USP
• Sodium ferric gluconate complex in sucrose injection (also known as iron gluconate)

Some of the differences in IV iron products are:

• How fast they work
• Whether or not a test dose is needed
• Types of side effects
• Size of the dose given
• Their approved indications

Outcomes
Understanding anemia and how it is treated will help you take good care of yourself. Remember:

• Anemia is common when you have chronic kidney disease
• Your healthcare team will determine which treatment is best for you
• If you have any questions, ask a member of your healthcare team

Venofer^® (iron sucrose injection, USP)

• An injectable IV iron
• Manufactured by American Regent, Inc.
• Ask your doctor if Venofer^® is the right IV iron for you

Epogen^® and Aranesp^® are registered trademarks of Amgen, Inc.  Procrit^® is a registered trademark of Ortho Biotech Products, L.P.
IMPORTANT SAFETY INFORMATION
Venofer ^® (iron sucrose injection, USP) is contraindicated in patients with evidence of iron overload, in patients with known hypersensitivity to Venofer ^® or any of its inactive components, and in patients with anemia not caused by iron deficiency.  Hypersensitivity reactions have been reported with IV iron products.  Hypotension has been reported frequently in hemodialysis dependent-CKD patients receiving IV iron, and has also been reported in non-dialysis dependent and peritoneal dialysis dependent-CKD patients receiving IV iron.  Hypotension following administration of Venofer ^® may be related to rate of administration and total dose delivered.

In multi-dose efficacy studies in hemodialysis dependent-CKD patients (N=231), the most frequent adverse events (>5%), whether or not related to Venofer ^® administration, were hypotension, cramps/leg cramps, nausea, headache, graft complications, vomiting, dizziness, hypertension, chest pain and diarrhea.  In post-marketing safety studies in hemodialysis dependent-CKD patients (N=1051), the most frequent adverse events reported (>1%) were congestive heart failure, sepsis and taste perversion.  In multi-dose efficacy studies in non-dialysis dependent-CKD patients (N=91), the most frequent adverse events ( ≥5%) whether or not related to Venofer ^® administration, were taste disturbance, peripheral edema, diarrhea, constipation, nausea, dizziness, and hypertension.  In the study of peritoneal dialysis dependent-CKD patients (N=75), the most frequent adverse events, whether or not related to Venofer®, reported by ≥5% of these patients were diarrhea, peritoneal infection, vomiting, hypertension, pharyngitis, peripheral edema and nausea.  

Please see Full Prescribing Information.