Anemia is a common complication in patients with chronic kidney disease (CKD), with renal anemia being a significant concern. As a result, new therapeutic agents are emerging for managing renal anemia. A recent study conducted in Nagasaki, Japan investigated the prevalence of iron deficiency in newly referred CKD patients and examined the factors associated with it. Learn what the scientists discovered about the effects of iron deficiency and supplementation in people living with advanced CKD.*

What the Researchers Did

For the study, researchers analyzed the iron levels of 361 patients with stage 4 or 5 CKD between 2018 and 2023. The patients’ characteristics, medication use, and concurrent conditions were included in the assessments.

What They Found

The analysis revealed that:

• Of the 361 patients, 47% of the patients had iron deficiency. 
• Iron deficiency was associated more strongly with:
  • Older age 
  • Female sex 
  • Lower eGFR
  • Use of renal anemia medications
  • History of ischemic heart disease
• Nephrosclerosis was a common cause of renal failure among these patients.

In addition:

• 9.7% were prescribed erythropoiesis-stimulating agents (ESAs)
• 9.4% were prescribed iron supplements
• 4.7% were prescribed hypoxia-inducible factor prolyl-hydroxylase inhibitors (HIF-PHIs)

The researchers found that patients on HIF-PHIs had significantly lower levels of ferritin (a protein in the blood that stores iron for future use) compared to those not on any renal anemia medications. According to the study authors, this suggests that HIF-PHIs may increase iron utilization.

What It Means

Iron deficiency in CKD patients can lead to anemia and increased cardiovascular risks, emphasizing the need for careful monitoring and management of iron levels.

Taken together, the study results indicate that:

• Patients with a history of ischemic heart disease require correction of iron deficiency to prevent worsening cardiac conditions.
• While ESAs and HIF-PHIs are effective in treating renal anemia, they should be used alongside iron supplementation to optimize treatment outcomes.
• CKD patients’ iron levels should be assessed regularly.

For patients with advanced CKD, particularly those on medications for renal anemia like ESAs and HIF-PHIs, the study highlights the importance of regular iron status assessment and appropriate supplementation to manage anemia effectively and reduce associated cardiovascular risks. This means a more comprehensive approach to anemia treatment, ensuring that iron deficiency is addressed to improve overall health outcomes.

*Kitamura, M., Yamashita, H., Kuroki, R., Fukuda, H., et al. (2024, May 25). Iron Deficiency in Newly Referred Patients With Chronic Renal Failure. Cureus 16(5): e61076. doi:10.7759/cureus.61076. https://www.cureus.com/articles/252319-iron-deficiency-in-newly-referred-patients-with-chronic-renal-failure#!/