Expert Panel Consensus on Management of Iron Deficiency Anemia and Use of Ferric Carboxymaltose in Hemodialysis-Dependent Chronic Kidney Disease Patients

Anemia is a common complication of CKD, contributing to adverse clinical outcomes, such as increased cardiovascular events, hospitalization rates, and mortality. Ferric carboxymaltose (FCM), has emerged as the preferred intravenous iron formulation, especially in patients with hemodialysis-dependent CKD (HD-CKD). Despite the widespread use of FCM, There is no consensus for intravenous (IV) FCM dosing and monitoring in India. A Delphi study was conducted in two phases to address these gaps. In the first phase, a literature review identified unmet clinical needs, resulting in 15 consensus statements evaluated by 70 experts using a 5-point Likert scale. The second phase involved an in-person meeting with 20 experts, where live polling achieved a ≥70% consensus on 10 statements, with the remaining statements revised for further validation. Key recommendations include initiating IV iron therapy when the transferrin saturation (TSAT) is ≤30% and the serum ferritin level is ≤500 ng/mL. FCM dosing should be weight-based (15 mg/kg) with a maintenance dose of 100-200 mg every 2-4 weeks. Regular monitoring of hemoglobin, TSAT, and serum ferritin levels is recommended to ensure effective management. This consensus introduces the novel I2M2 approach, i.e., Investigate, Initiate, Monitor, and Maintain, as a structured framework for managing iron deficiency anemia (IDA). Furthermore, this consensus offers practical guidance for optimizing treatment in IDA patients with HD-CKD within the Indian healthcare context.