Nephrology Dialysis Transplantation, Vol 12, Issue 6 1173-1181, Copyright © 1997 by Oxford University Press
J Braun, K Lindner, M Schreiber, R Heidler and W Horl
Background. The percentage of hypochromic red blood
cells (RBC), defined as those with a cellular haemoglobin <28 g/dl
has been suggested to be a sensitive marker of functional iron deficiency
in maintenance haemodialysis (HD) patients. Thus, during rHuEpo therapy an
increase in hypochromic RBC to >10% would indicate that more
intensive iron supplementation may be required.
Methods. We investigated 70 HD patients
57.1±15.3 years old and on maintenance HD for
66.3±47.9 months without blood loss from gastrointestinal
bleeding or from the vascular access, without surgery and without
infectious disease or malignancy. During the study period of 12 weeks, each
patient received an i.v. dose of 800 mg ferrogluconate. Haemoglobin,
haematocrit, and the percentage of hypochromic RBC were measured before and
every 4 weeks after the start of the study; serum ferritin, zinc
protoporphyrin (ZPP) and C-reactive protein (CRP) were measured at the
beginning (baseline) and end of the study. Results. At
baseline the percentage of hypochromic RBC was ⩽5.0% in 28
patients, >5.0 and ⩽10.0% in 25 patients and >10.0%
in 17 patients, suggesting functional iron deficiency in at least 42
patients, suggesting functional iron deficiency in at least 42 patients.
Nine patients had serum ferritin values <100 &mgr;g/l;
nonetheless in these patients the median percentage of hypochromic RBC was
5.9% (range 0.9-14.3%), indicating that an absolute iron deficiency can
occur in the presence of normal amounts of hypochromic RBC. There was a
significant correlation between serum ferritin levels and hypochromic RBC
at the end, but not at the beginning, of the study. However, there was no
correlation between ZPP and hypochromic RBC at any time during the study.
During i.v. iron supplementation the rHuEpo dose could be reduced by 8.5%
in patients with hypochromic RBC ⩽5.0%, by 11.3% in patients with
hypochromic RBC>5.0 and ⩽10.0% and by 23.4% in patients with
hypochromic RBC>10.0%, demonstrating the benefit of i.v. iron in
patients with functional iron deficiency. In HD patients in whom serum
ferritin levels remained below 290 &mgr;g/l until the end of the study,
a significant reduction of the rHuEpo dosage could be obtained during i.v.
iron therapy. This was not the case in patients with serum ferritin
>290 &mgr;g/l after iron supplementation. We found that the
percentage of hypochromic RBC is the most sensitive parameter for
predicting hyporesponsiveness in CPR-positive patients. Finally our data
indicate that HD patients with hypochromic RBC>6% and low to moderate
increases in serum ferritin levels after i.v. iron supplementation
significantly benefit from i.v. iron therapy. Conclusions.
Two different aspectsshould be taken into consideration in HD
patients treated with rHuEpo and concomitant i.v. iron therapy: (1)
response of the erythropoietic system to rHuEpo, and (2) adequate delivery
of the supplemented iron to the erythropoietic system. The patient's
percentage of hypochromic RBC and increase in serum ferritin after i.v.
iron supplementation should be used to decide whether or no i.v. iron
should be given and to monitor this type of therapy in HD patients.
Keywords: rHuEpo; iron supplentation; hypochromic red
blood cells; serum ferritin;zinc protoporphyrin; haemodialysis
ORIGINAL ARTICLES
Percentage of hypochromic red blood cells as predictor of erythropoietic and iron response after i.v. iron supplementation in maintenance haemodialysis patients
Haemodialysis Unit Nurnberg, Department of Medicine IV, Division of Nephrology, University of Erlangen-Nurnberg, Nurnberg, Germany; Department of Medicine III, Division of Nephrology, University of Vienna, Vienna, Austria; Corresponding author address: KfH-Dialysezentrum Nurnberg, Virnsbergerstr. 43, 90431 Nurnberg, Germany
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