American Board of Internal Medicine (ABIM) Certification Practice Exam

For hemodialysis patients requiring iron replacement, what route of administration is recommended?

1. Oral iron replacement

2. Intravenous iron replacement

3. Subcutaneous iron replacement

4. Intramuscular iron replacement

The correct answer is: Intravenous iron replacement

In patients undergoing hemodialysis, intravenous iron replacement is the recommended route of administration primarily for a few reasons. First, these patients often present with iron deficiency due to chronic blood loss during dialysis, reduced dietary intake, and the inflammatory process associated with their condition. Iron is essential in the synthesis of hemoglobin, and maintaining adequate levels can help manage anemia commonly seen in this population. Intravenous iron allows for a more immediate and effective replenishment of iron stores since it bypasses the gastrointestinal tract. Oral iron replacement can be limited by absorption issues that are exacerbated in patients with renal impairment, as well as by gastrointestinal side effects that may lead to non-compliance. When iron is administered intravenously, it can reach the systemic circulation quickly and can increase serum ferritin and transferrin saturation levels more rapidly than oral formulations. Other routes such as subcutaneous or intramuscular administration are not typically preferred for iron replacement in this context due to variability in absorption and the potential for pain and complications at the injection site. Intravenous iron also provides the ability to administer larger doses in a single session, which can be more efficient for patients on a strict dialysis schedule. Therefore, intravenous administration is the most effective and recommended approach for iron replacement in