Breaking the Cycle in Cardiorenal Anemia Syndrome: The Practice-changing Role of IV Iron at the CKD–Heart Failure Interface

All clinicians managing patients with non-dialysis-dependent chronic kidney disease or heart failure must be aware of the deleterious impacts of concomitant anemia and the established, emerging, and practice-changing role of intravenous (IV) iron therapies. The vicious cycle of cardiorenal anemia syndrome (CRAS)—the pathologic triad wherein the three 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.

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Target Audience

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.

Learning Objectives

  • 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 chronic kidney disease (CKD) and heart failure (HF) disease progression.
  • Describe proposed mechanisms of interrelationship between non–dialysis-dependent chronic kidney disease (NDD-CKD), heart failure (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 TSAT as diagnostic laboratory indices for 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 (ESAs) 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 (TDI).
  • 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.

Presented by Creative Educational Concepts, LLC.
Supported through an independent educational grant from American Regent.

Additional Information

PDF icon Slide Handout and References2.79 MB
PDF icon General Information746.67 KB
PDF icon Transcript3.95 MB
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Course opens: 
Course expires: 
  • Welcome and Introductions
  • The Vicious Cycle of Cardiorenal Anemia Syndrome: Pathophysiologic Principles and the Central Role of Iron Deficiency
  • The Elements of Change: Exploring the Utility of Intravenous Iron at the Nexus of NDD-CKD, Heart Failure, and Anemia
  • Closing Chasms in CRAS Care: Case-based Clues for Integrating IV Iron into the Therapeutic Armamentarium
  • Conversations with the Experts

Matthew R. Weir, MD
Activity Chair
Director, Division of Nephrology
Professor of Medicine
University of Maryland Medical System
Baltimore, MD


Javed Butler, MD, MPH, MBA
President, Baylor Scott and White Research Institute
Dallas, TX
Distinguished Professor of Medicine
University of Mississippi
Jackson, MS


It is the policy of Creative Educational Concepts, LLC, (CEC) to ensure independence, balance, objectivity, and scientific rigor and integrity in all their CME/CE activities. Activity planners, faculty, peer reviewers, and CEC staff must disclose to the participants any relationships with ineligible entities whose products or devices may be mentioned in this CE activity, or with the commercial supporter of this CE activity. An ineligible entity is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Financial relationships may include research grants, consultant fees, travel, advisory boards, consultancy, speakers’ bureaus, other benefits, or having a self-managed equity interest in a company.

CEC has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Matthew R. Weir, MD–has disclosed that he is an advisor or consultant to Akebia, AstraZeneca, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Janssen, Merck, Novo Nordisk, and Vifor Pharma.

Javed Butler, MD, MPH, MBA–has disclosed that he is on the speaker's bureau for AstraZeneca, Boehringer lngelheim, Lilly, Janssen, and Novartis. He is also a consultant to Abbott, Adrenomed, Amgen, Applied Therapeutics, Array, AstraZeneca, Bayer, Boehringer lngelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, lnnolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Roche, UvaNova, and Vifor.

Peer Reviewer:
Donna S. Hanes, MD–has no relevant financial relationships to disclose in relation to the content of this activity.

CEC Staff:
Bryan C. Taylor, PharmD–has no relevant financial relationships to disclose in relation to the content of this activity.
Jessica Hall–has no relevant financial relationships to disclose in relation to the content of this activity.

Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. CEC, the faculty, and any commercial supporter of this activity do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.


In support of improving patient care, Creative Educational Concepts is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.


Medicine (ACCME)
CEC designates this live educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
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