| [ Summary ] |
The prior Japanese Guidelines for renal anemia published in 2008 encouraged iron administration only when "serum ferritin levels were < 100 ng/ml AND TSAT < 20 %". This dramatically increased the number of ESRD patients with iron deficiency (ID). The administration of intravenous iron to such iron-depleted patients induced rapid hemoglobin elevation. As a result, we had no choice but to reduce ESA dosage, leading to worsening "hemoglobin cycling". Randomized controlled trials involving women with non-anemic ID, as well as patients with heart failure and ID have clearly disproved the conservative notion of "no anemia, no harm." In addition to the cardioprotective effects in terms of hospitalization due to worsening heart failure, iron administration has been reported to normalize cognitive functions and symptoms of restless leg syndrome. The practice pattern prioritizing ESA exclusively over iron therapy often leads to increased platelet counts or platelet activation due to ID. No rationale exists to extrapolate the harms shown with intravenous iron administration to those with oral iron administration. |