Iron supplementation therapy in end-stage renal disease patients on maintenance hemodialysis

Iron supplementation therapy seems almost indispensable in adequate management of the patients with end - stage renal disease on maintenance hemodialysis, since at least one and a half grams iron is considered to be required per year to keep sufficient erythropoiesis. Iron supplementation in conjunction with erythropoietic-stimulating agents is widely carried out as a standard therapy. However, definite diagnosis of iron deficiency in hemodialysis patients is often difficult since serum ferritin levels increase frequently by various reasons including inflammation and malignancy. Although several guidelines to treat anemia of the hemodialysis patients have been proposed, they seem still insufficient and careful clinical observation is required in individual patient to avoid possible complications of iron overload. We, here, reassess the adequate iron supplementation therapy in those patients, and the necessity of new guideline employing recent advances including magnetic resonance imaging - based method (FerriScan) and hemoglobin content per each reticulocyte is also discussed.