Renal Anemia and Iron Metabolism

Normal iron metabolism is essential for effective hemoglobin (Hb) production in the management of renal anemia. Considering that studies regarding the optimal Hb levels predated the creation of the iron management indices found in the treatment guidelines for hemodialysis (HD) patients, an increase in the Hb levels caused by intravenous iron supplementation has been used as an iron management index. However, no consideration was given to iron metabolism or the long-term safety of intravenous iron supplementation. Although iron is a vital trace element in humans, it can also be toxic, and its metabolism is carefully controlled, with several factors affecting it. Considering that the details regarding the mechanisms underlying iron metabolism have been elucidated recently, a study regarding iron management that is safe and considers iron metabolism status effective for Hb production in patients with renal anemia is warranted. This study presents information regarding iron metabolism in patients on HD, the factors that influence iron metabolism in such patients, and the problems with existing treatment guidelines in Japan, apart from discussing the optimal iron levels and optimal Hb production indices.