Intravenous iron therapy: well-tolerated, yet not harmless

Abstract In the majority of patients with chronic renal failure, it is essential to substitute erythropoietic agents and iron to maintain a haemoglobin level above 11 g dL −1 . Intravenous iron is more effective than oral iron. Substitution of intravenous iron is mainly performed using iron(III)‐hydroxide–sucrose complex (iron sucrose) and iron(III)–sodium‐gluconate in sucrose (iron gluconate), and is, in general, well‐tolerated. Nonetheless, intravenous iron therapy has effects on endothelial cells, polymorphonuclear leucocytes and cytokines which are most likely related to non‐transferrin bound labile iron. These effects suggest a role of iron in infection or atherosclerosis. Yet, not all available data support the association of iron with infection and atherosclerosis. A recent trial showed that iron sucrose is safe when given as treatment for iron deficiency or for maintenance of iron stores. Nevertheless, iron therapy should be handled with cautiousness but its use should not be feared whenever indicated.