Iron Deficiency Anemia

A prevalent condition in CKD?

Iron deficiency anemia (IDA) is indicated by depletion of the body’s iron stores, resulting in the formation of fewer, smaller red blood cells (RBCs) with lower hemoglobin (Hgb) content (microcytic hypochromic anemia).

IDA may occur in chronic kidney disease (CKD) patients and is typically marked by the following biochemical characteristics^{18,19,23,27,29}:

• Decreased iron saturation of transferrin
• Increased levels of soluble transferrin receptor present in plasma
• Decreased reticulocyte Hgb levels

Disturbances in iron metabolism may result in iron deficiency

Iron deficiency can result from any condition in which dietary iron intake fails to meet the body’s iron requirements. In CKD patients, a number of irregularities in iron homeostasis can lead to iron deficiency, including²⁹:

• Decreased iron absorption
• Decreased iron storage
• Decreased transferrin²²
• Accelerated erythropoiesis from erythropoiesis stimulating agents (ESAs)³⁵
• Ongoing blood loss²²

Causes of iron deficiency in CKD

Click on sections of the table below to review a specific list of some of the causes of iron deficiency.

In addition to understanding the causes of IDA, it is important to distinguish between absolute iron deficiency and functional iron deficiency.

KDOQI is a trademark of the National Kidney Foundation.

Important Safety Information

Indication and contraindications

Feraheme is indicated for the treatment of iron deficiency anemia in adult patients with chronic kidney disease. Feraheme is contraindicated in patients with evidence of iron overload, known hypersensitivity to Feraheme or any of its components, and patients with anemia not caused by iron deficiency.

Warnings and precautions

In clinical studies, serious hypersensitivity reactions were reported in 0.2% (3/1,726) of subjects receiving Feraheme. Other adverse reactions potentially associated with hypersensitivity (e.g., pruritus, rash, urticaria or wheezing) were reported in 3.7% (63/1,726) of subjects. Patients should be observed for signs and symptoms of hypersensitivity for at least 30 minutes following Feraheme injection and the drug should only be administered when personnel and therapies are readily available for the treatment of hypersensitivity reactions. 1.9% (33/1,726) of Feraheme-treated subjects experienced hypotension. Please monitor for signs and symptoms of hypotension following each Feraheme injection. Excessive therapy with parenteral iron can lead to excess storage of iron with the possibility of iatrogenic hemosiderosis. Patients should be regularly monitored for hematologic response during parenteral iron therapy, noting that lab assays may overestimate serum iron and transferrin bound iron values in the 24 hours following administration of Feraheme. As a superparamagnetic iron oxide, Feraheme may transiently affect magnetic resonance diagnostic imaging studies for up to 3 months following the last Feraheme dose. Feraheme will not affect X-ray, CT, PET, SPECT, ultrasound, or nuclear imaging.

Adverse reactions

In clinical trials, the most commonly occurring adverse reactions in Feraheme treated patients versus oral iron treated patients reported in ≥2% of chronic kidney disease patients were diarrhea (4.0% vs. 8.2%), nausea (3.1% vs. 7.5%), dizziness (2.6% vs. 1.8%), hypotension (2.5% vs. 0.4%), constipation (2.1% vs. 5.7%) and peripheral edema (2.0% vs. 3.2%). In clinical trials, adverse reactions leading to treatment discontinuation and occurring in 2 or more Feraheme-treated patients included hypotension, infusion site swelling, increased serum ferritin level, chest pain, diarrhea, dizziness, ecchymosis, pruritus, chronic renal failure, and urticaria.

Please see full Prescribing Information for Feraheme.