Anemia of chronic renal failure: new treatment alternative.

Iron deficiency anemia can develop relatively early in the course of chronic renal failure (CRF). The clinical practice guidelines for the treatment of anemia in chronic renal failure established in the U.S., the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI), and in Canada, by the Canadian Society of Nephrology, recommend the use of intravenous iron therapy for iron supplementation in hemodialysis patients, most patients on peritoneal dialysis and some pre-dialysis patients. In an open-label, randomized, multicentre North American trial, an alternate form of intravenous iron, sodium ferric gluconate, was shown to be safe and effective in the management of iron-deficiency anemia in hemodialysis patients receiving erythropoietin. The study confirmed the concepts regarding iron therapy expressed in the U.S. NKF-DOQI Clinical Practice Guidelines that hemodialysis patients with serum ferritin below 100 ng/ml or transferrin saturation below 20% need supplementation with parenteral iron in excess of 1000 mg to achieve optimal response in hemoglobin/hematocrit (Hgb/Hct) levels.