Understanding Kidney Disease

Iron Deficiency Anemia in Chronic Kidney Disease

Iron is an essential mineral for the human body

Iron is the most abundant element on Earth. It is obtained from the diet and is a critical component of human blood (actually what makes it red). Iron is needed to make healthy red blood cells that carry sufficient oxygen throughout the body. When your body does not have enough iron, it will make fewer red blood cells or red blood cells that are too small. People with chronic kidney disease often have insufficient iron and don’t produce enough hemoglobin, the component of the red blood cell that carries oxygen. People with iron deficiency have low hemoglobin and therefore have less oxygen in their blood.

Iron Deficiency Anemia in CKD Quick Facts:

  • Iron deficiency is the most common cause of anemia in patients with chronic kidney disease
  • Prevalence of anemia increases as chronic kidney disease progresses
  • Anemia is twice as prevalent among patients with CKD compared with the general population,
    15.4% vs. 7.6%, respectively

Iron Deficiency Anemia in CKD Overview

Iron deficiency is the most common type of anemia and a common complication of chronic kidney disease. Anemia is a condition where the body does not have enough healthy red blood cells to deliver adequate oxygen throughout the body. This is caused by a lack of iron.

Iron deficiency is the most common type of anemia and a common complication of chronic kidney disease. Anemia is a condition where the body does not have enough healthy red blood cells to deliver adequate oxygen throughout the body. This is caused by a lack of iron.

Iron deficiency anemia begins to develop in the early stages of chronic kidney disease and tends to worsen as CKD progresses. The majority of symptoms are mild at first and develop slowly.

More than half of the people living with chronic kidney disease are iron deficient. It is estimated that approximately 16 million people in the U.S. today have stages 3-5 CKD, with approximately 1.7 million of these people under the care of a nephrologist. Of these patients, approximately 650,000 have received treatment for iron deficiency anemia.

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Understanding the Links Between Iron Deficiency Anemia and CKD

As CKD develops and progresses, (1) inflammation arises and increases, (2) which directly affects and increases hepcidin, (3) Hepcidin acts to decrease the iron available and iron absorbed, (4) which is associated with an increase in FGF23 (5)—a marker of CKD progression. Inflammation is also associated with an increase in FGF23 and with iron sequestration (lack of availability), and FGF23 can further increase inflammation (a positive feedback loop). References are available on the illustration.

References:

  1. Taal M, et. al. Brenner and Rector’s The Kidney, 9th ed. Philadelphia, PA: Elsevier Saunders; 2012.
  2. National Kidney Foundation: Kidney Disease Outcomes Quality Initiative (KDOQI). KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006;47(5 Suppl 3):S11-145.
  3. Stauffer ME, et al. Prevalence of Anemia in Chronic Kidney Disease in the United States. PLoS One. 2014;9:e84943.
  4. International Society of Nephology. Kidney Int. 2012;2:279-335.
  5. U.S. Renal Data System, USRDS 2017 Annual Data Report
  6. Keryx proprietary market research
  7. Locatelli et al. Clin J Am Soc Nephrology 2016;11:7:1269-80.
  8. Fishbane S, et al. Clin J Am Soc Nephrology 2009;4:57-61.
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