A recent update on the management of iron deficiency in patients with chronic renal failure (CRF), either with or without anemia discusses the recommendations of the guidelines, new studies and new findings of iron deficiency and its impact on clinical outcomes.

One of the most common complications of chronic renal failure (CRF) is anemia. It not only alters the quality of life of the patients but also increases the chances of morbidity and mortality.

Iron deficiency (absolute or functional) is commonly observed in non-dialysis CRF patients, which may lead to anemia or a low response to erythropoiesis-stimulating agents. So the correction of this deficiency is a must.

The current guidelines recommend Iron replacement therapy in patients with CRF and anemia (Hb<12 g / dL). However, if Hb> 12 g / dL (absolute or functional iron deficiency) the opinions vary.

Intravenous iron replacement therapy is found to be safer, superior in efficacy and rapidly acting compared to oral therapy for achieving desired hemoglobin levels and minimizing the dose of erythropoiesis-stimulating agents. 

Intravenous iron in non-dialysis chronic renal failure patients given in high doses and low frequency will prove convenient for the patient, better conserving of the venous tree, safer and cost-effective.  Iron deficiency correction, in the absence of anemia, benefits as functional improvement in patients with heart failure, and in muscle function or fatigue in patients without CRF.

However, more studies are necessary to describe the usefulness of the correction of iron deficiency in the absence of anemia on morbidity and mortality, quality of life and physical capacity in the patients.

Source- Cases A, Puchades MJ, de Sequera P, Quiroga B, Martin-Rodriguez L, Gorriz JL, Portolés J; enrepresentación del Grupo de Anemia de la S.E.N.. Iron replacement therapy in the management of anemia in non-dialysis chronic renal failure patients: Perspective of the Spanish Nephrology Society Anemia Group. Nefrologia. 2021 Mar-Apr;41(2):123-136. English, Spanish. doi: 10.1016/j.nefro.2020.11.003. Epub 2021 Jan 28. PMID: 33516607.