Target Audience and Goal Statement

Nephrologists, cardiologists, and primary care physicians who help manage patients with cardiorenal anemia syndrome, including non–dialysis-dependent chronic kidney disease (NDD-CKD), heart failure (HF), or both.

The goal of this activity is for the learners to be better able to determine intravenous (IV) iron safety and efficacy and recognize the need for multidisciplinary care for patients with cardiorenal anemia syndrome.

Upon completion of this activity, participants will be able to: 

• Evaluate the fundamental facets of the "pathologic triad" in cardiorenal anemia syndrome (CRAS), with a particular focus on the multifaceted effects of concomitant anemia on CKD and HF disease progression
• Describe proposed mechanisms of interrelationship between NDD-CKD, HF, and anemia, with a renewed emphasis on the pathophysiologic impact of iron deficiency (ID)
• Discuss the basic tenets of iron metabolism and absorption in NDD-CKD and HF, including the essential utility of serum ferritin and transferrin saturation (TSAT) as diagnostic laboratory indices for iron deficiency (ID) and iron deficiency anemia (IDA) assessment and treatment decisions
• Appraise completed, ongoing, and planned clinical trials establishing the safety and efficacy of IV iron therapies for ID/IDA in both NDD-CKD and HF, and identify pivotal data readouts that have influenced current practice and consensus guidelines
• Investigate the emerging clinical potential of IV iron to safely and effectively treat anemia of CRAS and, thereby, reduce the progression of both NDD-CKD and HF and optimize patient outcomes across the continuum
• Examine IV iron as a therapeutic adjunct/alternative to erythropoiesis-stimulating agents for patients with CRAS
• Identify how the innovative nanoparticle design of next-generation IV iron agents dramatically improves upon the safety profiles of older generation products, with anaphylaxis and severe hypersensitivity rates as low as 0.1%
• Use a real-world, case-based format to analyze how CRAS inflammatory molecular signatures and elevated hepcidin levels impact the comparative clinical utility of oral vs IV iron supplementation modalities for ID/IDA management in NDD-CKD and HF
• Compare and contrast currently FDA-approved IV iron products, including approved indications and practical clinical differentiators, such as the capacity for total dose infusions
• Design iron repletion treatment plans for patients with CRAS using innovative, evidence-supported clinical tools, such as diagnostic algorithms, integrated digital checklists, and Ganzoni’s formula

All clinicians managing patients with NDD-CKD or HF must be aware of the deleterious impacts of concomitant anemia and the established, emerging, and practice-changing role of IV iron therapies. The vicious cycle of CRAS -- the pathologic triad wherein the 3 conditions are each capable of causing and/or being caused by the other -- can be effectively mitigated and managed with IV iron. Unfortunately, clinician hesitancy in prescribing IV iron, largely due to adverse effects associated with earlier formulations, must be overcome before the full benefit of IV iron in CRAS can be realized. Join Drs. Matthew Weir and Javed Butler as they address CRAS pathophysiology, examine applicable expert consensus guidelines, and review current evidence for treatment. Practical, case-based elements will be offered that provide learners with real-world examples of IV iron safety, efficacy, and the need for multidisciplinary (nephrologist-cardiologist-PCP) care.