International Urology and Nephrology

, Volume 44, Issue 2, pp 499–507

Iron overdose: a contributor to adverse outcomes in randomized trials of anemia correction in CKD

Nephrology – Review

DOI: 10.1007/s11255-011-0028-5

Cite this article as:
Van Buren, P., Velez, R.L., Vaziri, N.D. et al. Int Urol Nephrol (2012) 44: 499. doi:10.1007/s11255-011-0028-5


Administration of intravenous iron to supplement erythropoiesis stimulating agents (ESAs) has become a common practice in the management of anemia in patients with end-stage renal disease. Randomized clinical trials of anemia correction in this population have shown more adverse outcomes in CKD and ESRD patients assigned to the higher hemoglobin targets. Retrospective analysis of these trials suggests that morbidity is higher in subjects who fail to achieve the designated hemoglobin target and are typically exposed to higher doses of ESAs and iron than those that easily achieve the intended targets. Intravenous iron administration circumvents the natural biologic mechanisms for handling and utilization of iron. There is in vitro and in vivo evidence that intravenous iron preparations can cause oxidative stress, endothelial dysfunction, inflammation, impaired immunity, and renal injury. Since iron overload is known to promote endothelial dysfunction, cardiovascular disease, and immune dysfunction which are the leading causes of premature mortality in CKD and ESRD patients, it is imperative to exercise caution with the use of IV iron preparations in this population. The present review is intended to provide a brief overview of the potential adverse effects of the overzealous use of these agents.


AnemiaIronHemodialysisEnd-stage renal diseaseChronic kidney disease

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  1. 1.Departments of Internal Medicine/NephrologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Dallas Nephrology AssociatesDallasUSA
  3. 3.Division of Nephrology and HypertensionUniversity of California IrvineIrvineUSA
  4. 4.Department of PathologyThe University of Texas Southwestern Medical CenterDallasUSA
  5. 5.Division of Nephrology and HypertensionUniversity of California Irvine Medical CenterOrangeUSA