CORRECTION OF IRON DEFICIENCY IN CKD V HD PATIENTS WITH ANEMIA

Abstract

Hemodialysys results in loss of15-20 ml of blood or 5-7 mg of iron during each session or at least 1 g/ year. Additional iron may be lost through the gastrointestinal tract and during the menstruation in women. Excluding others possible reasons (genitourinary issues, laboratory investigations iron losses can amount minimum 1.7g per year). Dietary iron intake (0.5 – 1.0 g/year) only partially offsets iron deficit. According to KDOQI Anemia Guidelines (2006), “the average iv iron needed to maintain a stable serum ferritin (SF) level and in that way neutral iron balance, appears to be range 22-65 mg/week; this amount corresponds with SFl > 200 mg/ at but the same time there is no sufficient evidence to recommend routine administration of iron if SF > 500 mg/l. KDIGO Guidelines (2012) do not recommend routine use of iron supplementation in patients with transferrin saturation (TSAT) > 30% and SF > 500 mg/1. Thereby the target SF and TSAT levels in CKD VD patients remain controversial and in practice are determined by specific clinical tasks requiring resolution: to increase hemoglobin level without erythropoiesis stimulating agents (ESA) administration, or to decrease ESA dose in its turn depends on specific patient’s iron status (absolute or functional iron deficit) and treatment period, – predialysis or dialysis.

Keywords

• iron deficiency, serum ferritin, transferrin saturation, erythropoiesis stimulating agent, iron containing medicine.