1. Pathophys of IDA in CKD 2. Types and modes of iron repletion 3. Therapeutic targets
Lets start with a question to warm up…
What is the role of Hepcidin in anemia of CKD?
3/ Chronic inflammation + decreased clearance - ↑ hepcidin in CKD pts
Iron absorption starts → apical membrane of the GI tract. Released into the blood via the basolateral membrane through ferroportin
Hepcidin promotes degradation of Ferroportin ↓ the release of iron → blood
4/ So, how much iron do we actually need?
We use ferritin and Tsat to help guide us
The levels for non dialysis patients are not backed up by robust clinical trials, but evidence suggests that an aggressive approach is beneficial for our patients.
5/ What is your prefered mode (PO vs IV) of Iron replacement in CKD non dialysis patients?
6/ 1st choice for CKD non-dialysis patients is usually PO.
It is readily available without prescription
It is cheap and avoids the need for IV access
@NephMadness 2021 has a great article on Oral vs IV Iron, check it out!
11/ Another study comparing ferric citrate to ferrous sulfate showed ferric citrate outperformed ferrous sulfate with no significant difference in adverse effects