Evaluating traditional iron measures and exploring new options for patients on hemodialysis

Despite the use of recombinant human erythropoietin (rHuEPO), anemia remains a major problem in patients with chronic kidney disease and end stage renal disease. In addition, these disease states are often complicated by iron deficiency, especially in patients on chronic hemodialysis. Adequate iron supplies are necessary for normal erythropoiesis to occur and for the patient to effectively respond to rHuEPO treatment. Therefore, it is important for the nephrology nurse to have reliable iron test data in order to accurately monitor a patient's iron status. The two primary tests used to assess iron status are transferrin saturation and serum ferritin level. Both tests are easy to perform and are cost-efficient but have limitations and are highly variable under certain physiologic condtions, such as inflammation and infection. Due to these limitations, research has focused on alternative methods of iron assessment, with some newer techniques being more effective than others. Although nephrology nurses depend on transferrin saturation and serum ferritin levels to indicate iron status, they should recognize the associated restrictions and treat the patient based on a complete evaluation.