Iron deficiency anemia is a common occurrence in patients with chronic kidney disease and many patients do not respond well to supplementation with oral iron. There are now five intravenous iron preparations available for use in the chronic kidney disease patient, with ferumoxytol being the most recently approved agent. As opposed to previously available intravenous irons, ferumoxytol has the advantage of not needing a test dose, allowing a large dose of iron (510 mg) to be given in a short period of time by bolus injection, and no reported cases of anaphylaxis. Ferumoxytol has advantages for use in the outpatient setting to treat iron deficiency, in patients with chronic kidney disease not yet on dialysis and in patients on peritoneal dialysis. The use of ferumoxytol in the hemodialysis population where thrice weekly intravenous access is the norm is less clear. Cost-effectiveness studies and post-approval studies on ferumoxytol as well as changes in the cost structure of dialysis reimbursement will likely have a large impact on the use of this new agent.
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