Iron deficiency is a common condition among patients with chronic kidney disease (CKD). A large-scale, epidemiological analysis suggests that the majority of patients with impaired renal function have low levels of iron, with approximately 58% of men and over 70% of women reaching the haematological definition of iron deficiency. Rather than being a feature of later stages of disease only, iron deficiency has been reported from as early as CKD stage 3.1

Multiple factors contribute to the development of iron deficiency in CKD patients:

  • Blood loss: In CKD patients, blood loss can occur due to frequent phlebotomy, and if the patient is undergoing haemodialysis for their condition, through blood retention in the dialysis filter and line, and access bleeding.1 Additionally, if applicable, blood can also be lost during surgery.1
  • Malabsorption and inflammation: Inflammation associated with chronic disease can result in iron deficiency. Cytokine-mediated increases in the iron homeostasis hormone hepcidin inhibit mobilisation of iron from iron storage cells. In the short term, this can result in functional iron deficiency. Over the longer term, elevated hepcidin can lead to absolute iron deficiency by preventing transport of iron from intestinal enterocytes into the body.2
  • Increased demand for iron due to ESA therapy: Erythropoiesis-stimulating agents (ESAs) are widely used in patients undergoing haemodialysis as a treatment for anaemia. ESAs reduce the pool of circulating iron by increasing erythropoiesis, and iron supplementation may be required concomitantly.2 Iron deficiency can be a major cause of non-responsiveness to ESA therapy, with associated negative implications for anaemia correction and healthcare costs.3

Clinical benefits from correcting iron deficiency & iron deficiency anaemia in CKD

Iron therapy is widely used to treat iron deficiency in CKD, and to raise haemoglobin levels either alongside or in place of, ESA therapy. Effective iron replacement often allows a reduction in ESA dose.4

Randomised controlled trials have demonstrated that iron supplementation provides clinical benefits in patients with CKD and iron deficiency anaemia, including significant increases in haemoglobin levels.3,6 Other benefits of iron therapy can include improvements in physical performance, immune function, cognition, and restless legs syndrome.5,6

Further information

For further detailed information please follow the links below to, an educational programme exclusively available to healthcare professionals interested in nephrology. In addition to this, you can also visit, another educational online resource which provides healthcare professionals with current information on the management of iron deficiency.