[Iron replacement in hemodialysis patients with a normal serum ferritin level]

Iron deficiency limits the efficacy of recombinant human erythropoietin (rhEPO) therapy in end-stage renal disease patients. Therefore it is essential that serum ferritin levels should be maintened > 200 micro g/l. Functional iron deficiency occurs with serum ferritin levels > 200 micro g/l and transferrin saturation (TFS) lower than 20 %. The purpose of this study was to determine the efficacy of iron therapy in dialysis patients with serum ferritin levels higher than 200 micro g/l.

A total of 16 stable patients receiving chronic hemodialysis completed a 6-month survey period. Hemodialysis therapy and weekly subcutaneous rhEPO dose remained unchanged. Patients were divided into three groups according to their TFS, with TFS low (<20 %), barely adequate (20 % < TFS < 25 %) or optimal (>30 %). Sodium ferric gluconate complex (62.5 mg iron) was administered once per week intravenous over 10 minutes at the end of the dialysis.

After 3 months, hemoglobin was significantly higher in all groups (10.3 +/- 0.7 g/dl to 12,6 +/- 1.3 g/dl; p < 0,01) with no difference between the three groups and was constant in the following 3 months. Intravenous iron therapy raised ferritin levels significantly after 3 and 6 months: this observation was similar in all groups. The rise in TFS varied between and within the three groups.

Consistent intravenous iron therapy in combination with subcutaneous rhEPO had a rapid effect on the correction of anemia in patients with even optimal serum ferritin levels receiving chronic hemodialysis. There was no difference between patients with low, barely adequate and optimal TFS. It is concluded that there is a need for consistent intravenous iron therapy also in hemodialysis patients with optimal serum ferritin levels to correct anemia.