Nephrology Dialysis Transplantation, Vol 13, Issue 10 2572-2577, Copyright © 1998 by Oxford University Press
J Silva, S Andrade, H Ventura, J Santos, S Colaco, C Oliveira and P Ponce
Background. The aim of this prospective study was to
test a new protocol for iron supplementation in haemodialysis patients, as
well as to assess the utility of different iron metabolism markers in
common use and their 'target' values for the correction of iron deficiency.
Methods. Thirty-three of 56 chronic haemodialysis
patients were selected for long-term (6 months) i.v. iron therapy at 20 mg
three times per week post-dialysis based on the presence of at least one of
the following iron metabolism markers: percentage of transferrin saturation
(%TSAT) <20%; percentage of hypochromic erythrocytes (%HypoE)
>10% and serum ferritin (SF) <400 &mgr;g/l. Reasons for
patient exclusion were active inflammatory or infectious diseases,
haematological diseases, psychosis, probable iron overload (SF ⩾400
&mgr;g/l) and/or acute need of blood transfusion mostly due to
haemorrhage and change in renal replacement treatment. Results.
More than half (51.8%) of the patients of our dialysis centre
proved to have some degree of iron deficiency in spite of their regular
oral iron supplementation. At the start of the study the mean haemoglobin
was 10.8 g/dl and increased after the 6 months of iron treatment to 12.8
g/dl (P<0.0001). The use of erythropoietin
decreased from 188 units/kg/week to 84 units/kg/week. The criterion for
iron supplementation with the best sensitivity/specificity relationship
(100/87.9%) was ferritin <400 &mgr;g/l. Patients with ferritin
<100 &mgr;g/l and those with ferritin between 100 &mgr;g/l
and 400 &mgr;g/l had the same increase in haemoglobin but other
parameters of iron metabolism were different between the two groups.
Conclusions. Routine supplementation of iron in
haemodialysis patients should be performed intravenously. Target ferritin
values should be considered individually and the best mean haemoglobin
values were achieved at 6 months with a mean ferritin of 456 &mgr;g/l
(variation from to 919 &mgr;g/l). The percentage of transferrin
saturation, percentage of hypochromic erythrocytes and ferritin <100
&mgr;/l, were not considered useful parameters to monitor routine iron
supplementation in haemodialysis patients. No significant adverse reactions
to iron therapy were observed. Keywords:
erythropoietin; ferritin; haemodialysis; iron; intravenous
ORIGINAL ARTICLES
Iron supplementation in haemodialysis - practical clinical guidelines
Unidade de Hemodialise, Hospital Garcia de Orta, Bairro do Matadouro, Pragal, 2800 Almada, Portugal; Corresponding author
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