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ERA-EDTA 2017: Updates on the safety of IV iron and the role of iron beyond renal anaemia

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Date of publication: June 5, 2017

Medical Education

Module 3: Anaemia therapy in patients with CKD

Iron deficiency anaemia (IDA) is an acknowledged co-morbidity of chronic kidney disease (CKD),(1,2) and the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) clinical guidelines provide recommendations on its diagnosis and treatment as part of the management of anaemia in patients with CKD.(3) Iron therapy has become one of the mainstay treatments for anaemia in CKD and several oral and intravenous (IV) formulations are available, (4,5) each with different physicochemical properties, dosages and administration methods.(6)

This e-learning module was developed with the scientific input and guidance from Professor Simon Roger (Consultant Nephrologist at the Renal Unit, Gosford Hospital, Gosford, Australia.) and Professor Lawrence McMahon (Director of the Department of Renal Medicine and Obstetric Medicine at Eastern Health, and Professor of Nephrology at Monash University, Melbourne, Australia). The module is available in a user-friendly interactive presentation format that is divided over four chapters to enable you to learn at your own pace and gain maximum benefit from the information presented.

Chapter 1 reviews the options that are available to treat and manage anaemia in patients with CKD (i.e. oral iron, IV iron, erythropoiesis-stimulating agent (ESA) and blood transfusion), including the benefits and limitations of each treatment. Chapter 2 explores the importance of assessing iron parameters in CKD and the role that iron therapy plays in the management of anaemia in both the non-dialysis and haemodialysis CKD settings, and highlights some of the recommendations from the 2012 KDIGO guidelines. Chapters 3 and 4 describe the various oral and IV iron preparations, respectively, available for the management of anaemia in CKD, and examine how differences in the mechanism of action can influence drug metabolism and/or explain some of the side effects observed.

Interactive question-and-answer sections at the end of each chapter will evaluate your learning and improve your understanding of the anaemia therapy in patients with CKD.

References

  1. Macdougall IC, Horl WH, Jacobs C, et al. European best practice guidelines 6-8: assessing and optimizing iron stores. Nephrol Dial Transplant 2000;15 Suppl 4:20–32.
  2. Fishbane S, Pollack S, Feldman HI, et al. Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988-2004. Clin J Am Soc Nephrol 2009;4:57–61.
  3. KDIGO Clinical Practice Guideline for Anaemia in Chronic Kidney Disease. Kidney Int Suppl 2012;2:283–287.
  4. Macdougall IC. Iron supplementation in the non-dialysis chronic kidney disease (ND-CKD) patient: oral or intravenous? Curr Med Res Opin 2010;26:473–482.
  5. Del Vecchio L, Locatelli F. Anemia in chronic kidney disease patients: treatment recommendations and emerging therapies. Expert Rev Hematol 2014;7:495–506.
  6. Geisser P, Burckhardt S. The pharmacokinetics and pharmacodynamics of iron preparations. Pharmaceutics 2011;3:12–33.

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