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Erythropoiesis-independent effects of iron in chronic kidney disease

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Abstract

Chronic kidney disease (CKD) leads to alterations of iron metabolism, which contribute to the development of anemia and necessitates iron supplementation in patients with CKD. Elevated hepcidin accounts for a significant iron redistribution in CKD. Recent data indicate that these alterations in iron homeostasis coupled with therapeutic iron supplementation have pleiotropic effects on many organ systems in patients with CKD, far beyond the traditional hematologic effects of iron; these include effects of iron on inflammation, oxidative stress, kidney fibrosis, cardiovascular disease, CKD-mineral and bone disorder, and skeletal growth in children. The effects of iron supplementation appear to be largely dependent on the route of administration and on the specific iron preparation. Iron-based phosphate binders exemplify the opportunity for using iron for both traditional (anemia) and novel (hyperphosphatemia) indications. Further optimization of iron therapy in patients with CKD may inform new approaches to the treatment of CKD complications and potentially allow modification of disease progression.

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OA is supported by the K08 DK114558 from the NIH NIDDK and by the Rohr Family Clinical Scholar Award from Weill Cornell Medicine.

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  1. Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA

    Edwin Patino

  2. Department of Pediatrics, Division of Pediatric Nephrology, Weill Cornell Medical College, New York, NY, USA

    Oleh Akchurin

  3. New York-Presbyterian Hospital, New York-Presbyterian Phyllis and David Komansky Children’s Hospital, Weill Cornell Medicine, 505 East 70th Street - HT 388, New York, NY, 10021, USA

    Oleh Akchurin

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Patino, E., Akchurin, O. Erythropoiesis-independent effects of iron in chronic kidney disease. Pediatr Nephrol 37, 777–788 (2022). https://doi.org/10.1007/s00467-021-05191-9

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