The Impact of Inflammation and Oxidative Stress on Anemia Development in Chronic Kidney Disease: Mechanisms and Therapeutic Implications

Background: Anemia is a common and significant complication in patients with Chronic Kidney Disease (CKD) that can lead to adverse outcomes such as cardiovascular events, reduced quality of life, and accelerated progression to end-stage renal disease (ESRD). Iron deficiency and insufficient erythropoietin (EPO) levels are key mechanisms in the development of anemia in CKD. While erythropoiesis-stimulating agents (ESAs) are used to manage anemia, their efficacy is often compromised in patients with iron deficiency. Objective : To explore the effects of iron deficiency and erythropoiesis-stimulating agents (ESA) on anemia management and kidney function in CKD, focusing on the underlying mechanisms involved. Methods : This observational study included 120 patients with CKD stages 3 to 5, with measurements of hemoglobin levels, iron parameters (serum ferritin and transferrin saturation), estimated glomerular filtration rate (eGFR), and inflammatory markers (C-reactive protein) at baseline and after 6 months. Data were analyzed using statistical methods including paired t-tests, one-way ANOVA, and multivariate regression analysis to explore the relationships between iron status, ESA therapy, anemia progression, and kidney function decline. Results : At baseline, 65% of the cohort was iron deficient. ESA therapy, in combination with iron supplementation, was associated with a significant increase in hemoglobin levels (mean increase of 2.5 g/dL, p < 0.001) and a slower rate of eGFR decline compared to those not receiving ESA therapy. Intravenous iron supplementation significantly improved iron parameters and enhanced ESA response, contributing to better management of anemia and kidney function preservation. Conclusion : Iron deficiency plays a critical role in anemia treatment in CKD, and combining ESA therapy with iron supplementation, particularly intravenous iron, improves anemia control and may help slow the progression of kidney disease. These findings highlight the importance of addressing iron deficiency in CKD patients to improve both hematologic and renal outcomes. Further studies are needed to investigate the long-term effects of this therapeutic approach.