Iron Supplementation Stopping Criteria

Evidence-Based Guidelines

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend stopping oral iron supplementation when ferritin reaches ≥800 ng/mL AND TSAT ≥20%, or when TSAT reaches ≥40% regardless of ferritin level, to prevent iron overload while ensuring adequate iron stores 1, 2
• The American Journal of Hematology suggests stopping iron when ferritin >800 ng/mL or TSAT >50% for cancer-related anemia, defining this range as "iron replete" status 3

Stopping Criteria

• Stop oral iron supplementation immediately if TSAT ≥40% (regardless of ferritin) 1, 2
• Stop oral iron supplementation if ferritin ≥800 ng/mL AND TSAT ≥20% 1, 2

Safety Considerations

• Never exceed ferritin >800 ng/mL in routine practice, as this approaches iron overload territory 1, 2, 3
• The upper safety limit for ferritin in cancer patients is 1200 ng/mL, but this should not be a target 3

Monitoring and Resumption

• Recheck iron parameters 3 months after stopping oral iron 4
• Resume supplementation if ferritin drops below 100 ng/mL or TSAT falls below 20% 4
• In hemodialysis patients, maintain ferritin >200 ng/mL and TSAT >20% to minimize ESA requirements 4