Conclusions and Future Directions
ID is highly prevalent among KTRs and is an independent risk factor for premature mortality in this population. Potential mechanisms include direct effects on cardiac and skeletal muscle metabolism. Iron status also influences the immune system at various levels, but whether this impacts the risk of infection or rejection remains unclear. Iron supplementation might influence phosphate homoeostasis and the microbiome in KTRs, and therefore studies addressing the efficacy and safety of supplementation are needed. Iron supplementation in iron-deficient KTRs without overt anaemia is currently not recommended by guidelines, in the absence of supporting evidence.
The established beneficial effects of ID correction in CHF patients and ESRD patients, as recently demonstrated in the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial, warrant prospective studies to demonstrate the clinical effects of iron supplementation in KTRs.[6] A randomized, controlled clinical trial to investigate the effect of FCM versus placebo on exercise capacity and quality of life in KTRs, and to explore its effects on phosphate metabolism, among others, is currently ongoing (EFFECT-KTx, ClinicalTrials.gov NCT03769441). More studies are required to establish which is the optimal ID definition in KTRs, to further clarify its impact on morbidity and mortality, and to define optimal ID management strategies in KTRs.
Funding
This work has been supported by the Dutch Kidney Foundation (grant no 17OKG18). M.F.E. has received consulting fees from Vifor Pharma. D.A.H. has received lecture and consulting fees from Astellas Pharma and Chiesi Farmaceutici SpA, as well as grant support from Astellas Pharma, Chiesi Farmaceutici and Novartis. M.H.d.B. has received consulting fees from Amgen, Astra Zeneca, Bayer, Kyowa Kirin, Pharmacosmos, Sanofi Genzyme and Vifor Fresenius Medical Care Renal Pharma (all to employer).
Nephrol Dial Transplant. 2021;36(11):1976-1985. © 2021 Oxford University Press
