From the Guidelines
For patients with chronic kidney disease (CKD) on iron tablets, the goal of ferritin levels should be between 200-500 ng/mL, as this range supports erythropoiesis and prevents iron-deficiency anemia, while avoiding excessive iron stores. This recommendation is based on the most recent and highest quality evidence available, which suggests that maintaining a serum ferritin level above 200 ng/mL is essential for effective red blood cell production, particularly in patients receiving erythropoiesis-stimulating agents (ESAs) 1.
The evidence from the Kidney International Supplements study 1 indicates that patients with a serum ferritin target of 200 ng/mL or higher had lower ESA doses and better maintenance of hemoglobin levels. Additionally, the American Journal of Kidney Diseases study 1 recommends a ferritin level above 200 ng/mL for patients undergoing ESA therapy, with an upper limit of 500 ng/mL.
Key considerations for iron therapy in CKD patients include:
- Monitoring ferritin, transferrin saturation, and hemoglobin levels regularly to adjust oral iron supplements as needed
- Avoiding excessive iron stores by maintaining ferritin levels below 500 ng/mL
- Using oral iron preparations such as ferrous sulfate, ferrous gluconate, or ferrous fumarate, taken between meals with vitamin C to enhance absorption
- Avoiding concurrent administration with phosphate binders, antacids, or certain antibiotics that can reduce absorption.
Overall, the goal of iron therapy in CKD patients is to support erythropoiesis, prevent iron-deficiency anemia, and maintain optimal ferritin levels, while minimizing the risk of excessive iron stores and related complications 1.
From the Research
Goal of Ferritin for Patients with CKD on Iron Tablets
The goal of ferritin for patients with Chronic Kidney Disease (CKD) on iron tablets is to restore and maintain adequate iron stores, which is essential for erythropoiesis and overall health.
- Ferritin levels are used to assess iron stores in the body, with low levels indicating iron deficiency and high levels indicating iron overload 2, 3, 4, 5, 6.
- The target ferritin level for patients with CKD on iron tablets varies, but generally, a level of 100-500 ng/mL is considered adequate 3, 4.
- Iron supplementation, either orally or intravenously, is commonly used to increase ferritin levels and improve anemia in patients with CKD 2, 3, 4, 5, 6.
Iron Supplementation and Ferritin Levels
- Intravenous iron supplementation has been shown to be effective in increasing ferritin levels and improving anemia in patients with CKD, particularly those on dialysis 2, 3, 4.
- Oral iron supplementation, such as ferrous sulfate, can also increase ferritin levels, but may be less effective than intravenous iron and may cause gastrointestinal side effects 5, 6.
- Ferric citrate, an oral medication, has been shown to be effective in increasing ferritin levels and improving iron parameters in patients with CKD and iron deficiency 6.
Monitoring Ferritin Levels
- Regular monitoring of ferritin levels is essential to ensure that iron stores are adequate and to adjust iron supplementation as needed 2, 3, 4, 5, 6.
- Ferritin levels should be monitored in conjunction with other iron parameters, such as transferrin saturation and hemoglobin levels, to ensure that iron supplementation is effective and safe 2, 3, 4, 5, 6.