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Measurement of the liver iron concentration (<jats:styled-content style=\"fixed-case\">LIC<\/jats:styled-content>) reflects total body iron stores in patients with secondary hemosiderosis and genetic hemochromatosis. Recent studies of <jats:styled-content style=\"fixed-case\">LIC<\/jats:styled-content> in hemodialysis patients, measured by quantitative <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> and magnetic susceptometry, have demonstrated a high risk of iron overload in dialysis patients treated with <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> iron products at doses advocated by current anemia management guidelines for dialysis patients. Liver iron overload causes increased production of hepcidin and elevated plasma levels, which can activate macrophages of atherosclerotic plaques. This mechanism may explain the results of 3 long\u2010term epidemiological studies which showed the association of excessive <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> iron doses with increased risk of cardiovascular morbidity and mortality among hemodialysis patients. A more physiological approach of iron therapy in <jats:styled-content style=\"fixed-case\">ESRD<\/jats:styled-content> is needed. Peritoneal dialysis patients, hemodialysis patients infected with hepatitis C virus, and hemodialysis patients with ferritin above 1000\u00a0\u03bcg\/L without a concomitant inflammatory state, all require specific and cautious iron management. Two recent studies have shown that most hemodialysis patients will benefit from lower maintenance <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> iron dosages; their results are applicable to American hemodialysis patients. Novel pharmacometric and economic approaches to iron therapy and anemia management are emerging which are designed to lessen the potential side effects of excessive <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> iron while maintaining hemoglobin stability without an increase in <jats:styled-content style=\"fixed-case\">ESA<\/jats:styled-content> dosing.<\/jats:p>","DOI":"10.1111\/sdi.12732","type":"journal-article","created":{"date-parts":[[2018,6,29]],"date-time":"2018-06-29T00:23:00Z","timestamp":1530231780000},"page":"22-29","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["When should iron supplementation in dialysis patients be avoided, minimized or withdrawn?"],"prefix":"10.1111","volume":"32","author":[{"given":"Guy","family":"Rostoker","sequence":"first","affiliation":[{"name":"Ramsay\u2010G\u00e9n\u00e9rale de Sant\u00e9 Division of Nephrology and Dialysis H\u00f4pital Priv\u00e9 Claude 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