Iron deficiency anaemia: a frequent complication in chronic kidney disease (CKD)

Iron deficiency anaemia is a common complication in patients suffering from chronic conditions, and chronic kidney disease is unfortunately no exception. In this article we will see how iron is able to improve the clinical condition of patients suffering from chronic kidney disease and how to improve their quality of life.

What is chronic kidney disease?

Chronic Kidney Disease (CKD) described all pathological conditions affecting the kidneys and which can cause the progressive and complete loss of kidney function, making replacement therapy necessary -from dialysis to kidney transplants, in the most severe cases.
The most frequent causes of chronic kidney disease are diabetes and hypertension, but not only: triggers also include genetic predisposition, infections, auto-immune diseases and other renal diseases.

In patients suffering from CKD, iron deficiency, and consequent anaemia, are very frequent complications, affecting 50% of pre-dialysis patients.

What are the causes of iron deficiency anaemia in persons suffering from chronic kidney disease?

The main cause of anaemia in CKD patients is due to the lower production of the hormone erythropoietin (EPO) by the kidneys, the aim of which is to support the normal erythropoiesis process, i.e., the production process of new red blood cells in the bone marrow.

To correctly restore the erythropoiesis process, chronic kidney disease sufferers frequently receive treatment with synthetic EPO, which can be administered intravenously or by subcutaneous injection. It is usually administered intravenously in patients under dialysis, as it must be administered 2-3 times a week by qualified hospital staff; on the other hand, subcutaneous injections are preferred for patients not yet in dialysis, and can be done autonomously at home.

Iron deficiency however limits the effectiveness of EPO therapy, as the synthesis of red blood cells requires a good availability of the mineral in order to work correctly; it is therefore important that EPO therapy always be associated to iron supplements.

Chronic inflammation is also another trigger of iron deficiency, as it limits the absorption and use of iron by the body. In patients with chronic inflammation, conventional oral iron supplements are not able to solve the problem, as the body produces pro-inflammatory cytokines, which stimulate the production and increase the levels of hepcidin, a peptide hormone produced in the liver, which acts to reduce iron concentrations in the blood.  For this reason, in advanced CKD, iron supplements are generally administered intravenously; although this is effective in quickly restoring iron levels, it can cause adverse reactions due to the high oxidising power of iron in the blood circulation.

Solutions for iron deficiency

To combat iron deficiency, PharmaNutra has developed SiderAL^®, a new patented solution called Sucrosomial^® Iron, an innovative oral formulation in which ferric pyrophosphate is encapsulated in a matrix of phospholipids and sucrose esters of fatty acids. The result of this technology leads to high gastrointestinal tolerability and easier iron absorption in the intestines.

In recent years, much scientific evidence (both pre-clinical and clinical) has been published in international scientific journals confirming the effectiveness of Sucrosomial^® Iron; some of these clinical studies were carried out in the nephrology field, demonstrating how SiderAL^® is able to restore normal blood levels and guarantee the normal function of red blood cells and haemoglobin.

Conclusion

The innovation of Sucrosomial^® Technology lies in its excellent tolerability, allowing iron to be taken any time of the day (with or between meals), for long periods, preventing any disturbances usually associated with iron intake, such as an unpleasant metallic after-taste, irritation of the stomach lining, nausea or constipation. Overcoming the limits linked to conventional iron supplements, Sucrosomial® Iron makes it easier to administer this important nutrient in all cases of deficiency or increased iron needs.

Iron supplements for CKD sufferers significantly improves both the patients’ quality of life and clinical condition.

BIBLIOGRAPHY:

• Pisani A et al.; Effect of liposomal iron versus intravenous iron for treatment of iron deficiency anaemia in CKD patients: a randomized trial. Nephrol Dial Transplant. 2015 Apr;30(4):645-52. doi: 10.1093/ndt/gfu357. Epub 2014 Nov 13.
• Reggiani F. et al.; Preliminary experience on the use of sucrosomial iron in hemodialysis focus on safety, hemoglobin maintenance and oxidative stress. Int Urol Nephrol. 2022 May;54(5):1145-1153. doi: 10.1007/s11255-021-02983-8. Epub 2021 Sep 12.
• Gomez-Ramirez et al.; Sucrosomial^® Iron: A New Generation Iron for Improving Oral Supplementation. Pharmaceuticals (Basel). 2018 Oct 4;11(4):97.