Diagnosing and treating anemia and iron deficiency in hemodialysis patients

The availability of recombinant erythropoietin over the past decade has advanced the management of anemia in hemodialysis patients. However, total health care is often suboptimal because clinicians lack the appropriate understanding of the additional medical conditions associated with anemia. Confounding factors that are common during anemia include iron deficiency, infection/inflammation, and bleeding. Iron deficiency is especially problematic because it is prevalent, increases the severity of anemia, and reduces the ability of the patient to respond to treatment. Currently, the common laboratory parameters used to assess iron status are not accurate because they are influenced by extraneous factors. Newer methods, such as reticulocyte hemoglobin content (CHr), provide a more accurate estimate of available iron and should be used more often by health care providers. Therapy with intravenous (i.v.) iron should be also administered to achieve appropriate hemoglobin levels and iron stores. Once adequate levels of these parameters are reached, maintenance doses of i.v. iron should be administered to sustain red blood cell production.