Clinical Investigation

Kidney International (1989) 35, 712–716; doi:10.1038/ki.1989.43

Iron status in patients receiving erythropoietin for dialysis-associated anemia

David B Van Wyck1, John C Stivelman1, Joaquin Ruiz1, Linda F Kirlin1, Murray A Katz1 and David A Ogden1

1University of Arizona Departments of Internal Medicine and Geosciences, and the Veterans Administration Medical Center, Tucson, Arizona, USA

Correspondence: Dr David B Van Wyck, Veterans Administration Medical Center, Renal Section 111B, Tucson, Arizona 85723, USA.

Received 25 April 1988; Revised 22 September 1988.

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Abstract

Iron status in patients receiving erythropoietin for dialysis-associated anemia. Adequate body iron stores are crucial to assuring rapid and complete response to recombinant human erythropoietin (rHuEPO). In the present study, markers of iron storage were examined in 27 patients with normochromic, normocytic anemia undergoing acute rHuEPO (150 to 300 U/kg t.i.w.) treatment for anemia. We calculated projected iron needed for new hemoglobin synthesis from the difference between initial and target hemoglobin concentrations, initial iron reserves available from initial serum ferritin levels, and net projected surplus or deficit from the difference between needs and reserves. Of 22 patients predicted to develop iron deficiency (mean projected deficit 268 plusminus 70 mg), 20 developed evidence of exhausted iron stores (transferrin %sat< 16 or ferritin < 30 microg/liter) before reaching target hemoglobin; two predicted to become deficient (projected deficit < 100 mg) did not; and all five predicted to avoid iron deficiency (mean projected surplus 177 plusminus 20 mg) remained iron replete. During acute rHuEPO therapy net body iron balance remained neutral in patients receiving no iron supplements and increased 5 mg/kg in patients prescribed oral ferrous sulfate. However, in patients given iron dextran i.v. less than 60% of elemental iron administered became measurable as iron stores or usable for hemoglobin synthesis

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