Consequences of Untreated Iron Deficiency in CKD Patients
If iron deficiency anemia is not treated in patients with chronic kidney disease, they face significantly increased risks of death, cardiovascular complications, reduced quality of life, and greater need for blood transfusions. 1, 2
Critical Outcomes of Untreated Iron Deficiency Anemia
Mortality and Morbidity
- Untreated anemia in CKD is directly associated with increased mortality risk, with the severity of anemia correlating with death rates. 2, 3
- Patients experience increased cardiovascular morbidity, including higher rates of cardiovascular disease events when anemia remains uncorrected. 4, 5
- The overall risk-benefit ratio strongly favors treating iron deficiency compared to leaving it untreated or partially treated. 4
Quality of Life Impact
- Reduced health-related quality of life is a consistent finding in CKD patients with untreated anemia. 3
- Patients experience persistent anemia-related symptoms including fatigue, reduced exercise tolerance, and diminished functional capacity when iron deficiency goes untreated. 6
Transfusion Requirements
- Untreated iron deficiency leads to increased need for red blood cell transfusions, which carry their own risks including iron overload, transfusion reactions, and infectious complications. 6, 7
- The goal of iron therapy is specifically to reduce transfusion requirements, highlighting the clinical significance of untreated iron deficiency. 6
Impaired Erythropoiesis
- Iron deficiency prevents adequate response to erythropoiesis-stimulating agents (ESAs) if they are initiated, as erythropoiesis requires both erythropoietin and adequate iron availability. 1, 7
- Both absolute iron deficiency (depleted iron stores) and functional iron deficiency (adequate stores but unavailable for use) contribute to impaired red blood cell production in CKD. 2, 5
- The majority of CKD patients will develop iron deficiency as their disease progresses, particularly when GFR falls below 60 mL/min/1.73m². 1, 2
Clinical Context
The evidence strongly supports that untreated iron deficiency in CKD represents a modifiable risk factor for poor outcomes. The KDIGO guidelines emphasize that correcting iron deficiency should be addressed before or alongside other anemia interventions to optimize outcomes. 6
Iron supplementation improves survival, decreases morbidity, and increases quality of life when appropriately administered, making the consequences of non-treatment particularly significant from a clinical standpoint. 1