Incidence, Causes, and Treatment of Iron Deficiency Anemia in Hemodialysis Patients

Because an important factor in response to recombinant human erythropoietin (r-HuEPO) therap is adequate iron (Fe) availability, the investigators decided to assess Fe status of their hemodialysl (HD) patients before initiating r-HuEPO therapy. Of 104 patients not receiving r-HuEPO, 72% had transferrin saturation level less than 0.20 (20%), and 69% had a serum ferritin level less than 10 μg/L (100 ng/mL). The average hematocrit was 0.22 (22%). The investigators determined that the patients lose from 2 to 5 L of blood per year, amounting to a loss of 3 to 8 mg of Fe/treatment whe hematocrit is 0.22 (22%). If hematocrit is 0.30 (30%), Fe loss will be 4 to 11 mg /treatment. The ren; diet provides approximately 14 mg of Fe per day, comparable to only about 1 to 2 mg of absorbe Fe. Therefore, these patients require significant amounts of Fe replacement therapy because of th blood loss incurred and dietary inadequacies. Thirty-two patients with Fe deficiency anemia wer studied. Each subject had Fe studies consisting of serum Fe, total Fe binding capacity, transferri saturation, serum ferritin, and hematocrit evaluated weekly. Sixteen subjects received intravenou (IV) Fe dextran (IVFe Imferon, Fisons Pharmaceuticals, Rochester, NY) administered after eac dialysis for 5 weeks totaling 1.5 g, and 16 subjects received oral (PO) ferrous gluconate (POFe approximately 5 g (72 mg daily), given over 10 weeks. IVFe subjects increased hematocrit fror 0.19 to 0.27 (19% to 27%). All subjects treated with IVFe corrected transferrin saturation, and 771, corrected serum ferritin. Subjects treated with POFe improved hematocrit from 0.20 to 0.25 (20% t 25%), and two thirds of these subjects improved Fe status. Substantial numbers of HD patient exhibiting anemia have significant Fe deficiency largely due to blood loss. The renal diet i insufficient to combat this deficiency. IVFe is more efficient than POFe in treating Fe deficiency in HD patients.