Roles of Intravenous Iron Therapy in Various Patient Settings

Abstract

Objective:

To provide clinical information on intravenous iron products and their role in chronic kidney disease (CKD), dialysis, oncology, critical illness, and heart failure.

Data Sources:

Intravenous iron products information, national clinical practice guidelines, and the latest primary literature available were reviewed. PubMed and MEDLINE databases were searched from January 2000-December 2009.

Study Selection and Data Extraction:

All FDA-approved intravenous iron products information, available national clinical practice guidelines, and primary literature were included.

Data Synthesis:

Iron deficiency is common in patients with CKD, dialysis, oncology, critical illness, and heart failure. Routine supplementation with intravenous iron therapy is indicated in patients with CKD, including those receiving dialysis; however, its role in oncology, critical illness, and heart failure is not clearly defined. Assessing patients for iron deficiency, evaluating their status, and knowing the risks of adverse events are important in determining the roles of intravenous iron therapy in each setting. If patients are initiated on intravenous iron, they must be closely monitored for signs and symptoms of adverse drug reactions, as well as clinical worsening. Additionally, intravenous iron must be discontinued upon resolution of iron deficiency.

Conclusions:

The importance of intravenous iron therapy is well established in patients with CKD, including those receiving dialysis, who have iron deficiency. Its roles in oncology, critical illness, and heart failure should be assessed on a case-by-case basis.