Interpretation of Iron Status Test Results Should Incorporate Hb and ESA Dose
Monitoring response after a course of IV iron. Correction of a less-than-target Hb level during ongoing ESA therapy. Similarly, iron status testing is appropriate after treatment with a course of IV iron, to monitor safety and adequacy of therapy, and in a patient with hyporesponsiveness to ESA.Ĭlinical settings in which more frequent iron testing may be necessary include the following: Initiation of ESA therapy, correction of a less-than-target Hb level during ongoing ESA therapy, bleeding, and surgical procedures each are likely to promote depletion of iron stores and thereby may call for increased frequency of iron status testing. Use and interpretation of iron status tests in the initial evaluation of anemia are described in Guideline 1.2.įrequency of iron status testing during anemia management should be determined by the patient's Hb level relative to the target range and by the likelihood of blood loss. The purpose of iron status testing is to either evaluate anemia or guide the use of iron agents to achieve and maintain targets of iron therapy during anemia management. RATIONALEįrequency of Iron Status Tests Should Be Every 1 to 3 Months The stage of CKD and treatment setting (HD-CKD and PD-CKD) deserve consideration not only for practical reasons, but also because the quantity, quality, and strength of evidence vary among patients with ND-CKD, HD-CKD, and PD-CKD. Selecting a route of administration, dose, and class of iron agent requires an understanding of the efficacy, safety, and tolerability of available iron therapeutics. Designing appropriate iron therapy for patients with CKD-associated anemia requires an understanding of the interpretation of iron status test results, the therapeutic significance of iron status levels, and the therapeutic and safety limits of iron administration. Administered as adjuvants to ESAs, iron agents prevent iron deficiency and serve to minimize the dose of ESA needed to achieve target-range Hb levels. Iron agents may serve as primary therapy for selected patients (particularly those with ND-CKD) or as adjuvant therapy for those also undergoing treatment with an ESA. The goal of iron therapy in a patient with anemia and CKD is to achieve and maintain a target-range Hb level. In the opinion of the Work Group, resuscitative medication and personnel trained to evaluate and resuscitate anaphylaxis should be available whenever a dose of iron dextran is administered. ( STRONG RECOMMENDATION)ģ.2.5.2 In the opinion of the Work Group, the route of iron administration can be either IV or oral in patients with ND-CKD or PD-CKD. When ferritin level is greater than 500 ng/mL, decisions regarding IV iron administration should weigh ESA responsiveness, Hb and TSAT level, and the patient's clinical status.ģ.2.5 Route of administration: 3.2.5.1 The preferred route of administration is IV in patients with HD-CKD. In the opinion of the Work Group, there is insufficient evidence to recommend routine administration of IV iron if serum ferritin level is greater than 500 ng/mL. 
In the opinion of the Work Group, sufficient iron should be administered to generally maintain the following indices of iron status during ESA treatment: In the opinion of the Work Group, results of iron status tests, Hb, and ESA dose should be interpreted together to guide iron therapy.
In the opinion of the Work Group, iron status tests should be performed as follows:ģ.2.1.1 Every month during initial ESA treatment.ģ.2.1.2 At least every 3 months during stable ESA treatment or in patients with HD-CKD not treated with an ESA.ģ.2.2 Interpretation of iron status tests: (See Guideline 1.2 for diagnosis of iron deficiency.) Thus, the goals of iron therapy are to avoid storage iron depletion, prevent iron-deficient erythropoiesis, and achieve and maintain target Hb levels. Efficacy of iron therapy appears not to be limited to patients with evidence of iron deficiency. CLINICAL PRACTICE GUIDELINES AND CLINICAL PRACTICE RECOMMENDATIONS FOR ANEMIA IN CHRONIC KIDNEY DISEASE IN ADULTSĪnemia therapy in patients with CKD requires effective use of iron agents, guided by appropriate testing of iron status. NKF KDOQI Guidelines NKF KDOQI GUIDELINES KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease
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