Epidemic of Iron Overload in Dialysis Population Caused by Intravenous Iron Products: A Plea for Moderation

Vaziri reveals that common use of blood transfusion to treat anemia before the introduction of recombinant erythropoietin was associated with a high incidence of iron overload in patients on dialysis. Introduction of recombinant erythropoietin more than 2 decades ago nearly obviated the need for blood transfusion in this population. Because of recurrent loss of blood in hemodialysis circuits, blood samples taken for laboratory tests, mobilization of iron stores with recombinant erythropoietin therapy, and impaired intestinal iron absorption, patients on dialysis readily develop iron deficiency, which necessitates intravenous (IV) iron supplementation. Although judicious use of IV iron is indispensable for anemia treatment in patients on hemodialysis, its indiscriminate use can have serious consequences. Excessive use of IV iron intensifies chronic kidney disease-associated oxidative stress and inflammation, promotes endothelial dysfunction and cardiovascular disease, compromises immune system, increases the risk of infections by enhancing microbial growth and virulence and compromising host defense, and impairs insulin production and heightens insulin resistance.