Reticulocyte Hemoglobin Content Helps Avoid Iron Overload in Hemodialysis Patients: A Retrospective Observational Study

Abstract

Abstract. Background/Aim: Anemia in patients suffering from end-stage renal failure is currently treated with Erythropoiesis-Stimulating Agents (ESA). This treatment needs sufficient iron supplementation to avoid anPatients suffering from End-Stage Renal Disease (ESRD) represent a major health care problem with a significant cost, should they undergo hemodialysis treatment. Patients lose up to 5-7 mg of iron during each dialysis treatment and this is a primary cause of their iron-deficiency anemia (1, 2). There is also an increased need for iron supplementation to maintain Hb levels within the optimal range and maximize the response to ESA (3). As oral iron supplementation is often ineffective due to both patient non-compliance and gastrointestinal adverse effects, most dialysis patients receive IV iron to fill sufficient iron stores (4, 5). However, iron excess is stored in the liver causing organ toxicity and inflammation as well as an increased risk of infections (6, 7).ESRD patients generally need to be given ESA and IV iron together to achieve the optimal Hb concentrations (4). The majority of patients on hemodialysis receive an IV/subcutaneous ESA dose during each dialysis section (8). Values of transferrin saturation <20% and serum ferritin <100 ng/ml require iron supplementation. (9). There are not specific protocols for IV iron supplementation. Previous clinical studies have suggested the administration of iron saccharate at a total dose of 1g/14 days (two administrations of 500 mg or five of 200 mg) (10) or iron gluconate at a total 709