Nephrology Dialysis Transplantation, Vol 13, Issue 1 82-88, Copyright © 1998 by Oxford University Press
M Kooistra, E Niemantsverdriet, A van Es, N Mol-Beermann, A Struyenberg and J Marx
Background: The response to recombinant human
erythropoietin (rHuEpo) is determined primarily by the availability of
iron. In contrast to i.v. iron, oral iron supplementation is often
insufficient for an optimal response. Method: We
studied iron absorption and the effects of iron status, aluminium status
and inflammation in 19 chronic haemodialysis patients on maintenance rHuEpo
therapy. Iron mucosal uptake after 24 h, iron retention after 2 weeks and
mucosal transfer of iron were determined with a whole-body counter using an
oral dose 59Fe. Iron absorption was measured once
without, and once after the ingestion of 2 g aluminium hydroxide.
Results: On the basis of transferring saturation, two
groups of dialysis patients were distinguished: a group with a functional
iron deficiency (n=9), and an iron-deficient dialysis patients group,
mucosal uptake, mucosal transfer, and iron retention were
49.9%±29.4, 0.73±0.29, and 41.6%±32.2,
being significantly lower than in a non-uraemic iron deficient population
(P <0.01, P <0.05, P <0.01 respectively). In the
iron-replete dialysis patients group, mucosal uptake, mucosal transfer, and
iron retention were 20.0±12.3, 0.59±0.18, and
11.1±6.7, mucosal uptake and iron retention being lower than in
a normal iron-replete population (P <0.0005 and P <0.003
respectively). Dialysis patients with high C-reactive protein (CRP) values
showed lower iron absorption. Iron absorption data correlated significantly
with transferrin saturation and CRP in the iron-deficient group, and with
serum ferritin in the iron-replete group. Iron absorption decreased after
an aluminium hydroxide challenge in the iron-deficient patients to the
lower levels of the iron-replete subjects. Body aluminium stores, estimated
by the desferrioxamine test, did not correlate with parameters of iron
absorption. Conclusion: The absorption of iron in
dialysis patients is decreased in haemodialysis patients, which may, at
least in part, be due to inflammation. Aluminium ingestion further reduces
absorption in functional iron-deficient patients. Key
words: anaemia; erythropoietin; iron absorption; haemodialysis
ORIGINAL ARTICLES
Iron absorption in erythropoietin-treated haemodialysis patients; effects of iron availability, inflammation and aluminium
Division of Nephrology and Hypertension, Department of Internal Medicine, and Eijkman-Winkler Institute, University Hospital, Utrecht, The Netherlands; Foundation for Home Dialysis Miden-West Nederland, Utrecht, The Netherlands; Hospital Hilversum and Dialysis Center 't Gooi, Hilversum, The Netherlands; Corresponding author at: Stichting Thuisdialyse Midden-West Nederland, Brennerbaan 130, 3524 BN Utrecht, The Netherlands
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