Current Issues in Iron Management in End-Stage Renal Disease

Fishbane, Steven; Maesaka, John K.

doi:10.1111/j.1525-139x.1997.tb00446.x

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…In addition to the aforementioned statistical link be-This analysis, derived from a nationally representative patient database, identifies an important area for im-tween laboratory surrogates of iron stores and hematocrit, previous intervention studies have demonstrated the provement, and a complimentary strategy for affecting it that is within the domain of the dialysis care team, that impact of iron deficiency on anemia correction in the absence and presence of epoetin alfa [1, [19][20][21][22]. For is, correction of iron deficiency.…”

Section: ͼ36% 13%mentioning

confidence: 99%

Anemia management of adult hemodialysis patients in the U.S.: Results from the 1997 ESRD Core Indicators Project

Frankenfield¹,

Johnson²,

Wish³

et al. 2000

Kidney International

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Section: ͼ36% 13%mentioning

confidence: 99%

Anemia management of adult hemodialysis patients in the U.S.: Results from the 1997 ESRD Core Indicators Project

Frankenfield¹,

Johnson²,

Wish³

et al. 2000

Kidney International

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Iron status and iron supplementation in peritoneal dialysis patients

Vychytil¹,

Haag–Weber²

1999

Kidney International

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Iron status and iron supplementation in peritoneal dialysisextent of iron loss and therefore a lower incidence of patients. Iron deficiency represents an important problem in iron deficiency during peritoneal dialysis treatment may peritoneal dialysis patients, especially during erythropoietin be one reason for the reported differences [8, 9]. Hocken therapy. A combination of serum ferritin, transferrin saturation, and Marwah found a mean blood loss into the dialyzer and/or the percentage of hypochromic red cells should be used of 9 ml per hemodialysis treatment, resulting in a total to assess iron status in peritoneal dialysis patients. Primarily, oral iron supplementation should be the preferred therapy. blood loss of 1400 ml per year [10]. Furthermore, blood However, most of the studies using oral substitution in erythroloss for laboratory investigations was 1.14 to 3.22 liter/ poietin-treated peritoneal dialysis patients show a progressive year for center-treated hemodialysis patients, but was decline of serum ferritin. Therefore, parenteral iron suppleonly 0.17 liter/year for home-treated hemodialysis pamentation is required in part of the patients, and the intravenous route should be preferred in these cases. Intravenous iron tients. The reported blood losses correspond to a loss of therapy is recommended if serum ferritin falls below 100 g/ elemental iron of up to 830 mg/year in hemodialysis liter and should be stopped if the serum ferritin level is more patients not receiving erythropoietin therapy. Milman than 650 g/liter. The optimal form of intravenous iron suppleestimated an iatrogenic blood loss of 150 to 200 ml per mentation is still unclear. Injections once to three times per month for hemodialysis patients, as compared with only week restrict the patients' flexibility, but application of higher doses in longer intervals may lead to an impairment of neutro-30 to 60 ml/month for peritoneal dialysis patients [11].phil functions, probably connected to a higher risk of infection.Despite the lesser extent of blood loss, there is much We treated 17 stable peritoneal dialysis patients with 100 or evidence from clinical experience that iron deficiency 200 mg iron saccharate monthly over a period of six months also plays a main role in peritoneal dialysis patients. In and found an increase of transferrin saturation (from 12.1 Ϯ 1.6 a study published by Blumberg, Marti and Graber, eight to 20.9 Ϯ 2.4%, P ϭ 0.026), serum ferritin (from 100.4 Ϯ 32.0 to 372.4 Ϯ 54.6 g/liter, NS) and hematocrit (from 32.0 Ϯ 0.8% of 20 continuous ambulatory peritoneal dialysis (CAPD) to 35.1 Ϯ 0.9%, P ϭ 0.099). The required erythropoietin dosage patients receiving neither iron nor erythropoietin supplecould be reduced significantly (from 148.4 Ϯ 30.3 to 69.4 Ϯ mentation had diminished bone marrow iron stores [2].19.5 U/kg/week, P ϭ 0.025). Side effects occurred in 0.9% after Another study of non-erythropoietin-treated peritoneal application of 100 mg and in 5.9% after injection of 200 mg iron saccharate. The incidence of catheter...

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