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Changes in the iron regulating hormone, hepcidin, lead to impaired iron absorption and release from stores. When patients on chronic dialysis need iron for make red blood cells, the hepcidin impairs iron availability, causing more anemia and higher epoetin doses. Proactive IV iron (regular, moderate doses) overcome the hepcidin blockade, improving anemia and lower epoetin doses. This also the chances of a patient having a major cardiac problem or even dying.

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This page is a summary of: Proactive high-dose IV iron is preferred therapy in ESKD patients: PRO, Kidney360, August 2021, American Society of Nephrology,
DOI: 10.34067/kid.0002442021.
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