Inflammatory state Loss of appetite/poor nutrition Reduced iron uptake from GI tract due to edema or common concomitant medications (e.g., histamine-2 receptor antagonists, calcium-based phosphate binders, antiplatelet therapies, and proton pump inhibitors)
Fatigue and reduced exercise capacity, work capacity, and quality of life Associated with increased hospitalization and mortality
Chronic kidney disease
Inflammatory state Reduced hepcidin excretion by the kidneys Blood loss from dialysis sessions Chronic intestinal bleeding (e.g., platelet dysfunction) Frequent phlebotomy Acute expansion of erythroid mass under ESA therapy Poor appetite
24–85% (highest incidence with more severe CKD) [15–17]
Iron-deficiency anemia associated with fatigue, increased mortality, and progression to end-stage renal disease
Inflammatory bowel disease
Inflammatory state Chronic blood loss from the GI tract Poor appetite Reduced uptake of iron from the GI tract Bowel resection
Fatigue, exhaustion, reduced exercise capacity and quality of life
CKD, chronic kidney disease; ESA, erythropoietin-stimulating agent; GI, gastrointestinal. Iron deficiency defined as serum ferritin < 100 μg/L or 100–300 μg/L [11–13] (or <800 μg/L [14]) with transferrin saturation (TSAT) < 20%. Iron deficiency defined as serum ferritin < 100 μg/L or TSAT < 20%. Iron deficiency defined as serum ferritin < 30 μg/L or TSAT < 16% [18, 19] or <20% [20] or as serum ferritin < 100 μg/L if C-reactive protein (CRP) > 5 mg/L [20] or >10 mg/L [18].
