"Intravenous iron has been shown to improve responsiveness to epoetin in selected patients with [chronic kidney disease]…and may reduce the amount of epoetin needed (if used) to achieve and maintain a target Hgb/Hct."2

NKF K/DOQI Clinical Practice Guidelines for
Anemia of Chronic Kidney Disease 2000 Update

	Target ranges for hemoglobin (Hgb) and hematocrit (Hct) are 11–12 g/dL and 33% to 36%, respectively2
	Hgb and Hct levels ≥11 g/dL and 33% are associated with increased survival in hemodialysis patients2
	96% of patients with chronic kidney disease will achieve the target Hgb/Hct with epoetin alfa (450 units/kg/wk IV or 300 units/kg/wk SC) within 4 to 6 months provided they have adequate iron stores2
	The majority of end-stage renal disease (ESRD) patients develop iron deficiency when epoetin therapy is started without iron supplementation2
	Oral iron is not likely to maintain the target transferrin saturation (TSAT), serum ferritin (SF), and Hgb/Hct in hemodialysis patients undergoing epoetin therapy2
	Most hemodialysis patients will require IV iron on a regular basis to compensate for hemodialysis-related blood loss2

NKF K/DOQI Clinical Practice Guidelines for
Anemia of Chronic Kidney Disease 2000 Update

Epoetin alfa therapy requires an adequate supply of iron and rapid mobilization of iron stores. Without adequate iron stores, epoetin will be relatively ineffective in increasing hemoglobin levels to desired target levels (>11 g/dL).2

According to the 2000 update of the NKF K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease, iron deficiency is the primary cause of epoetin resistance (ie, persistently low hemoglobin levels despite escalating doses of epoetin).2 Ensuring adequate iron stores before epoetin therapy through administration of repletion doses of IV iron and during epoetin therapy through administration of maintenance doses improves the response to epoetin. In addition, maintenance IV iron therapy, that is, the frequent administration of low doses of iron, has been shown in several studies to reduce epoetin requirements in hemodialysis patients.18-21