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Iron plays a critical role in the transport of oxygen and oxidative metabolism. Two important iron-containing proteins involved in these processes are hemoglobin and myoglobin. If stores of iron within the body become depleted, several processes are affected including erythropoiesis. As iron deficiency progresses and requirements for erythropoiesis are not met anemia may occur.



Adapted from Jacinto et al.1

Iron Deficiency Anemia and CKD
Chronic Kidney Disease (CKD) is a progressive disease that gradually impairs kidney function, usually over a period of years. It often progresses to end stage renal disease (ESRD), where the kidneys fail and renal replacement therapy such as dialysis or transplantation is required to sustain life. A significant complication of CKD is iron deficiency anemia, which develops early in the course of the disease and progresses with loss of renal function. Causes of iron deficiency in CKD patients include:


Functional Iron Deficiency vs Absolute Iron Deficiency
Functional iron deficiency is defined as a condition in which there is a failure to release iron rapidly enough to keep pace with the demands of the bone marrow for erythropoiesis, despite adequate total body iron stores. This condition is commonly associated with ESA usage:

  • Dramatic increase in RBC production, Hb, and Hct due to ESA
  • Iron uptake by erythroid cells is increased to meet demand of increased RBC production.
  • Reticuloendothelial cells are unable to release stores of iron fast enough to meet demand.
  • Despite adequate levels of stored iron (ferritin), insufficient iron is available for epoetin-stimulated RBC production.
  • Eventually iron deficiency erythropoiesis develops; the RBCs produced are small and have low Hb content.
  • In time, iron deficiency limits the response to epoetin therapy, and higher doses of epoetin are required to reach target Hb and Hct levels.


Absolute iron deficiency occurs when total body iron stores become depleted. The amount of stored iron is no longer adequate to meet the demands for erythropoiesis.

Lab Values to Differentiate Function and Absolute Iron Deficiency
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IMPORTANT SAFETY INFORMATION:

Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening and fatal, have been reported in patients receiving Venofer® (iron sucrose injection, USP). Patients may present with shock, clinically significant hypotension, loss of consciousness, and/or collapse. If hypersensitivity reactions or signs of intolerance occur during administration, stop Venofer® immediately. Monitor patients for signs and symptoms of hypersensitivity during and after Venofer® administration for at least 30 minutes and until clinically stable following completion of the infusion. Only administer Venofer® when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions.

Venofer® may cause clinically significant hypotension. Monitor for signs and symptoms of hypotension following each administration of Venofer®. Hypotension following administration of Venofer® may be related to rate of administration and total dose delivered.

Venofer® is contraindicated in patients with known hypersensitivity to Venofer®. Do not administer to patients with evidence of iron overload.

In efficacy studies in non-dialysis dependent-CKD patients (N=139), the most frequent adverse events (≥5%) whether or not related to Venofer® administration, were nausea (8.6%), taste disturbance

(7.9%), peripheral edema (7.2%), diarrhea (7.2%), dizziness (6.5%), hypertension (6.5%), infusion site pain or burning (5.8%), dyspnea (5.8%), and vomiting (5.0%).

In multi-dose efficacy studies in HDD-CKD patients (N=231), the most frequent adverse events (> 5%) whether or not related to Venofer® administration, were hypotension (39.4%), muscle cramps (29.4%), nausea (14.7%), headache (12.6%), graft complications (9.5%), vomiting (9.1%), dizziness (6.5%) hypertension (6.5%), chest pain (6.1%), and diarrhea (5.2%). In the study of PDD-CKD patients (N=75), the most frequent adverse events, whether or not related to Venofer®, reported by ≥5% of these patients were infections and infestations (nasopharyngitis, sinusitis, upper respiratory tract, pharyngitis) (16.0%), diarrhea (8.0%), vomiting (8.0%), hypertension (8.0%), peripheral edema (5.3%), and nausea (5.3%).


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References