Iron stores in patients on haemodialysis after renal transplantation

Patients with chronic renal failure receive iron orally and parenterally which can lead to iron overload. However, iron deficiency is common among Indians and it is not known whether the Indian dialysis and transplant patient runs a similar risk of iron overload. The iron status is best quantified by measuring serum ferritin levels when there is no intercurrent inflammatory process. We used this method to assess the iron stores in a random sample of the Indian population on our dialysis and transplantation programme.

Serum ferritin assay was done using ELISA on samples obtained from 24 patients at entry to dialysis, before renal transplant surgery and 3 to 6 months following the surgery. All patients received 120 mg of elemental iron orally and third party transfusions according to a fixed protocol.

None of the patients had iron deficiency despite low haemoglobin values. Fifteen patients at entry, 12 out of 16 pre-transplant and 10 out of 17 post-transplant patients had evidence of iron overload. Three patients developed iron overload during the period of observation and 6 of the 10 who entered the programme with evidence of iron overload continued to have iron overload.

Indian patients with chronic renal failure have evidence of iron overload similar to those in developed countries. Oral iron supplements in Indian patients are therefore unnecessary.