Iron Deficiency Anemia in Chronic Kidney Disease

Overview

Anemia, a shortage of healthy red blood cells, is common in chronic kidney disease (CKD). Damaged kidneys make less of the hormone that tells the body to produce red blood cells, and many people with CKD also run low on iron. Iron can be lost through dialysis and frequent blood draws, absorbed poorly from the gut, or locked away by inflammation. When iron is low, the body cannot make enough hemoglobin even if other anemia treatment is working.

Common Signs and Symptoms

• Tiredness or low energy
• Shortness of breath with everyday activity
• Pale skin
• Dizziness or light-headedness
• Cold hands and feet
• Trouble concentrating
• A fast or pounding heartbeat

When to Contact a Provider

Tell your nephrology team about new or worsening tiredness or breathlessness, because your blood count and iron levels may need to be checked. Chest pain, fainting or severe shortness of breath needs urgent care.

How Treatment May Help

Iron pills often work less well in CKD, so your nephrologist may prescribe iron by IV infusion instead. IV iron can help refill the body's iron stores and raise hemoglobin, which may help with tiredness and breathlessness. Your nephrologist uses blood tests, such as hemoglobin, ferritin and transferrin saturation, to decide whether you need iron and how much. Some people with CKD also need a medicine that stimulates red blood cell production; that part of care is prescribed and managed by your kidney team.

Therapies That May Be Available at Infuse Care

• Venofer (iron sucrose): IV infusion or slow IV injection, usually as a series of smaller doses; approved for iron deficiency anemia in people with CKD
• Feraheme (ferumoxytol): IV infusion, usually two doses three to eight days apart; for adults with iron deficiency anemia who have CKD
• Injectafer (ferric carboxymaltose): IV infusion, often two doses at least seven days apart; for adults with iron deficiency anemia who have CKD and are not on dialysis
• Monoferric (ferric derisomaltose): IV infusion, often a single dose; for adults with iron deficiency anemia who have CKD and are not on hemodialysis

Safety and Monitoring

Allergic reactions can occur with IV iron and, rarely, can be serious, so our nurses monitor you during the infusion and for at least 30 minutes afterward. Feraheme carries a boxed warning about serious allergic reactions. Injectafer can lower blood phosphate levels, so your provider may check them. Other possible side effects include headache, nausea, changes in blood pressure and discomfort at the IV site. Your iron levels are rechecked before any further doses.

Your prescribing provider decides which treatment is right for you. Infuse Care administers prescribed therapies after a referral, a clinical review and any required insurance authorization, and we keep your provider's office updated on your care.