Implementing an i.v. iron maintenance regimen protocol in a hemodialysis practice

Iron-deficiency anemia is commonly encountered in patients with end-stage renal disease (ESRD) requiring chronic hemodialysis and can occur as a result of blood loss from frequent laboratory tests, blood retention in the dialysis tubing and dialyzer, gastrointestinal (GI) bleeding, repeated access surgery, poor oral iron intake and/or absorption, and low protein diets (Sakiewicz, 1998; Eschbach, 1999). Further compounding the deficiency is the use of recombinant human erythropoietin (EPO), which stimulates erythropoiesis to abnormally high levels and leads to functional iron deficiency in up to 90% of patients (Macdougall, 1995; Sunder-Plassmann, 1997).