[How do we need to maintain the iron status in dialyzed patients treated with erythropoesis stimulating agents]

Anaemia associated with chronic kidney disease remains a major concern for nephrologists while it significantly increases morbidity and mortality in this patient group. Introduction of erythropoietin has dramatically changed the treatmant of anaemia in uraemic patients. All chronic kidney disease patients with renal anaemia undergoing treatment with an erythropoiesis-stimulating agent (ESA) should be given supplementary iron. Patients undergoing haemodialysis usually have greater iron requirements than those not undergoing dialysis. However, some patients showed hyporesponsiveness to LSE because of inadequate iron supply to the erythroid bone marrow. Intravenous administration is more effective than oral iron supplemantation in renal failure patients. Some studies have raised concerns over the potential serius side-effect associated with the intravenous iron administration. Besides the anaphylactic reactions that were reported to occur in less than 1% of patients treated with iron dextran, and has not been associated with other iron formulations, concerns about long-term use of iron include increased risk of infections and oxidative stress with the consequent cardiovascular disease. Therapy with dextran-free iron formulations is an essential part of anaemia treatment protocols, and was not found to be associated with either short- or long-term serious side-effects.