Absolute vs Functional Iron Deficiency

Total body iron vs supply and demand

Two major types of iron deficiency anemia (IDA) may occur in chronic kidney disease (CKD) patients:

• Absolute iron deficiency refers to the depletion of iron stores and the absence of stainable iron in the bone marrow.^30,35,37
  • Absolute IDA is defined as serum ferritin <100 ng/mL and transferrin saturation (TSAT) <20%
  • Dialysis dependent CKD (DD-CKD) patients are at a greater risk due to increased blood loss
  • Occurs when there is insufficient iron available for hemoglobin (Hgb) production
• Functional iron deficiency is a problem of supply and demand. It can occur when ESA therapy stimulates red blood cell (RBC) production beyond the available supply of iron necessary for Hgb synthesis; it can also be caused by chronic inflammation³⁵
  • Also known as relative iron deficiency
  • Serum ferritin >100 ng/mL and TSAT <20% indicates functional iron deficiency

What percentage of your CKD patients with anemia are iron deficient?
Find out more about the prevalence of IDA in CKD.

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.