Iron deficiency commonly complicates anemia in patients with chronic kidney disease¹. With the recent safety controversy surrounding ESA therapy,² the use of IV iron without ESAs may present an attractive and cost effective alternative for treating anemia. IV iron therapy can provide effective anemia management, even in the absence of an erythropoietin, in a substantial portion of these patients.

A stepwise approach to anemia management, with a trial of IV iron as primary therapy, followed by the addition of an ESA, if necessary, provides a practical option for anemia protocols, providing individualized, effective treatment and the lowest possible ESA dose. Efforts to develop and implement this type of protocol can have both significant clinical outcomes as well as economic benefits.³

In addition, The NKF-Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in CKD (discussed in more detail below) state that iron agents may serve as primary therapy for selected patients (particularly those with NDD-CKD) or as adjuvant therapy for those also undergoing treatment with an ESA. Administered as adjuvants to ESAs, iron agents prevent iron deficiency and serve to minimize the dose of ESA needed to achieve target-range Hb levels.⁴

Optimization of anemia management in NDD-CKD without ESA therapy
The efficacy of IV iron as primary therapy in anemic patients with non-dialysis dependent-CKD has been studied in 5 clinical trials.^5-9 Maintaining iron stores with Venofer^® (iron sucrose injection, USP) may allow avoidance or discontinuation of ESA therapy. Clinical trials have shown that in up to one-third of non-dialysis dependent-CKD patients with iron deficiency anemia, treatment with Venofer^® corrected anemia without an ESA.^6,7 Results from all five clinical studies indicate a hematopoietic response, defined as a rise in Hb of >1 g/dL, in patients treated with IV iron alone. Approximately 1/3 to 1/2 of treated patients were able to reach the target Hb/hematocrit (HCT) defined during the studies.

Optimization of erythropoietin therapy
Aggressive intravenous iron therapy with products such as Venofer^® is increasingly recognized as a means of optimizing the response to erythropoietin. Evidence from numerous studies^10-20 conducted since 1992, totaling more than 450 patients, shows that intensive intravenous iron supplementation (iron dextran, iron sucrose, or sodium ferric gluconate in sucrose complex) allows a reduction in erythropoietin dose of 19% to 70%.