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Clinical Place of Iron in the 21st Century

  • 1 Daniel W. Coyne, MD, is professor of medicine, division of nephrology at Washington University, St. Louis, MO.
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In 2018, expert opinion that our present strategies for the use of intravenous (IV) iron were harming chronic kidney disease (CKD) patients took a severe thrashing. Despite clear evidence that iron is essential for treating the anemia of CKD, generous IV iron use has been discouraged by guidelines and by many experts. Despite this advice, physicians in the United States have given more IV iron to dialysis patients than those in other regions of the world. The results from the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial, paired with the results from IV iron trials that include nondialysis

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