Iron Deficiency Anemia: Modern Approaches to Treatment with Iron Preparations
Iron deficiency anemia (IDA) is a widespread condition characterized by a lack of healthy red blood cells in the blood due to iron deficiency [3]. Despite its high prevalence, anemia often fails to receive proper clinical attention, and its detection, evaluation, and treatment may be insufficiently effective [3]. This condition has a significant impact on quality of life, increases the risk of morbidity and mortality, and may prolong hospital stays [3].
What is Iron Deficiency Anemia and Why is it Important?
Iron is a key component of hemoglobin, a protein in red blood cells that carries oxygen throughout the body. When iron is deficient, the body cannot produce a sufficient amount of hemoglobin, leading to anemia. Symptoms may include fatigue, weakness, pale skin, shortness of breath, and dizziness. IDA is a modifiable risk factor, meaning it can and should be treated to prevent more serious complications and improve overall health [3].
Anemia in Chronic Kidney Disease: A Special Risk Group
Anemia is particularly common in patients with chronic kidney disease (CKD), including those not on dialysis, as well as patients on peritoneal and hemodialysis, and kidney transplant recipients [5]. The main causes of anemia in this group are iron deficiency and a deficiency of erythropoietin, a hormone that stimulates red blood cell production [5, 6].
Anemia in CKD is associated with many adverse clinical outcomes [6]. Therefore, major international organizations such as Kidney Disease: Improving Global Outcomes (KDIGO) and the UK Kidney Association strongly recommend the treatment of anemia in patients with CKD [2, 5].
Iron Therapy: The Cornerstone of Treatment
Iron therapy is the basis of treatment for iron deficiency anemia and has received increasing attention in recent years [1]. It plays a key role both as the primary treatment method for IDA and as adjunctive therapy when using erythropoiesis-stimulating agents (ESAs) in patients with CKD [1, 5, 6].
Iron preparations are available in various forms, including oral and intravenous. The choice of form depends on the severity of anemia, patient tolerance, and the presence of comorbid conditions. For example, patients with CKD may use iron-containing phosphate binders, which help increase iron stores in the body [1].
Modern Approaches and New Horizons in Anemia Treatment
The introduction of erythropoiesis-stimulating agents (ESAs) into clinical practice was a major breakthrough, helping to increase hemoglobin levels without the need for frequent blood transfusions and significantly improving patients' quality of life [6, 8]. However, ESAs are not without drawbacks: they are expensive, require parenteral administration, and have potential side effects [1, 6]. Furthermore, randomized clinical trials have shown that higher target hemoglobin levels and/or high doses of ESAs can cause significant harm, leading to a reduction in their prescription and target hemoglobin levels [6, 8].
In light of these limitations, new drugs with improved safety and efficacy characteristics are actively being developed. Among them:
- Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHI): These drugs stimulate endogenous erythropoiesis by activating HIF activity. Some of them are already used in clinical practice [1, 5].
- Activin traps: Such drugs as sotatercept and luspatercept are in the stage of clinical development, mainly for indications other than CKD, but also demonstrate an additional effect in improving conditions associated with bone health [1].
These new strategies aim to achieve better safety, activity, and/or simpler and cheaper production compared to available ESAs [1].
Recommendations and Future Prospects
Anemia management, especially in CKD, is constantly improving. Updated clinical practice guidelines, such as KDIGO 2026 and the UK Kidney Association 2025, provide current guidance on the diagnosis, evaluation, and treatment of anemia, including the use of iron, ESAs, and HIF-PHIs [2, 5]. These guidelines are developed with the participation of patients, healthcare professionals, and researchers worldwide to provide a useful resource for decision-making [2].
The future of anemia treatment is associated with the further development of safer and more effective methods that can be more accessible and convenient for patients, as well as with the personalization of therapeutic approaches [1].
Sources
- Current and future chemical therapies for treating anaemia in chronic kidney disease. (Expert Opinion on Pharmacotherapy, 2017) https://pubmed.ncbi.nlm.nih.gov/28443351/
- Executive Summary of the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD). (Kidney International, 2026) https://pubmed.ncbi.nlm.nih.gov/41485807/
- Iron deficiency anemia--bridging the knowledge and practice gap. (Transfusion Medicine Reviews, 2014) https://pubmed.ncbi.nlm.nih.gov/24931617/
- UK kidney association clinical practice guideline: update of anaemia of chronic kidney disease. (BMC Nephrology, 2025) https://pubmed.ncbi.nlm.nih.gov/40240983/
- New Treatment Approaches for the Anemia of CKD. (American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 2016) https://pubmed.ncbi.nlm.nih.gov/26372086/
- Anaemia management in patients with chronic kidney disease: Taiwan practice guidelines. (Nephrology (Carlton, Vic.), 2014) https://pubmed.ncbi.nlm.nih.gov/25156587/
Disclaimer: The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified medical professional for diagnosis and treatment.