Iron Therapies

Iron Therapies

Haemodialysis, Iron Deficiency and Anaemia

In patients with end-stage renal disease, haemodialysis is used to substitute for lost kidney function and remove waste products (e.g. creatinine and urea) from blood. Patients undergoing regular haemodialysis are often iron-deficient due to the frequent blood loss associated with haemodialysis.

Non-dialysis Chronic Kidney Disease, Iron Deficiency and Anaemia

Decreased kidney function in patients with chronic kidney disease may reduce the stimulation of red blood cell synthesis and the utilisation of nutritional or stored iron. This can lead to the development of anaemia even in patients who are not on haemodialysis.

Kidney Disease Guideline: Improving Global Outcomes Clinical Practice Guideline for Anaemia in Chronic Kidney Disease1 emphasises the importance of recognising and treating iron deficiency first in the treatment of anaemia.
The new Guideline highlights iron therapy as a cornerstone in the treatment of anaemia, emphasising the importance of recognising and treating iron deficiency in CKD patients. A key component is the recommendation to address all correctable causes of anaemia, including iron deficiency, before initiating treatment with erythropoiesis-stimulating agents (ESAs). Treatment with intravenous iron is noted as a way to treat iron deficiency anaemia, which can avoid or reduce the use of ESAs, avoid or minimise blood transfusions, and help treat anaemia-related conditions, potentially through enhancing erythropoiesis and raising haemoglobin levels1.

More details available on the KDIGO website.

References
1. Kidney Disease: Improving Global Outcomes (KDIGO) Anaemia Work Group. KDIGO Clinical Practice Guideline for Anaemia in Chronic Kidney Disease. Kidney Int Suppl 2012;2:279–335

Cardiology, Iron Deficiency and Anaemia

Iron deficiency occurs frequently in patients with chronic heart failure and is associated with an increased risk of heart transplantation. Chronic inflammatory processes are often the main cause for impaired iron metabolism.

The current European Society of Cardiology Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure include a strong recommendation for the treatment of iron deficiency with Ferinject® in patients with systolic heart failure1. This mention is based exclusively on the findings of two double-blind, placebo-controlled clinical trials of Ferinject® in patients with CHF and iron deficiency ‒ FAIR-HF2 and CONFIRM-HF3. The benefits of Ferinject® treatment in these studies demonstrated significant improvements in heart failure symptoms, exercise capacity and quality of life.

More details available on the ESC website.

References
1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and  chronic heart failure. European Heart Journal. doi:10.1093/eurheartj/ehw128.
2. Anker SD, Comin-Colet J, Filippatos G, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009; 361:2436–2448.
3. Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al. Beneficial effects of long term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. European Heart Journal 2015;36:657–668.

 

Oncology, Chemotherapy-induced Anaemia

Some cancer patients may experience iron deficiency and anaemia. Both can result from chronic bleeding associated with certain tumour types (e.g. gastrointestinal tumours) and changes in the utilisation of iron induced by the tumour itself or different types of chemotherapy.

The recently updated version of the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Cancer- and Chemotherapy-Induced Anaemia1 recommend the use of intravenous (i.v.) iron in cancer patients to treat iron deficiency. These Guidelines acknowledge that i.v. iron has improved efficacy to the more commonly used oral iron, and should be considered in combination with ESA supplementation.

More details available on the NCCN website.

References
1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Cancer- and Chemotherapy-Induced Anaemia. Version 1.2013. Available at: http://www.nccn.org.

Gynaecology and Obstetrics, Iron Deficiency and Anaemia

Heavy menstrual bleeding, the high iron requirements of a growing foetus during pregnancy, and blood loss during childbirth, are three conditions that put women of childbearing age at greater risk of becoming anaemic or iron-deficient.

Menometrorrhagia or Heavy Menstrual Bleeding (Hmb)

Heavy uterine bleeding (HMB) is one of the most common and economically significant gynaecologic complaints . In clinical practice, HMB is the leading cause of iron deficiency with or without anaemia.

Gastroenterology, Iron Deficiency and Anaemia in Inflammatory Bowel Disease

Iron deficiency and iron deficiency anaemia are common complications in patients with inflammatory bowel disease (ulcerative colitis and Crohn’s disease) that result from chronic blood loss and chronic inflammation associated with the disease.

Patient Blood Management in Elective Surgery, Preoperative Anaemia

Surgery is associated with blood loss. Patients that are already anaemic before surgery have a higher risk of receiving a blood transfusion. Patient blood management focuses on avoiding blood transfusions by correcting anaemia before starting a surgical procedure, minimising blood loss during the surgery and optimising the anaemia treatment postoperatively.

Paediatrics, Iron Deficiency

Iron deficiency and iron deficiency anaemia can affect infants, children and adolescents. Menstruating young women are at particularly high risk of becoming iron deficient.