Monitoring of iron requirements in renal patients on erythropoietin

E. G. Anastassiades, D. Howarth, R. Gokal, J. Howarth, D. Shanks, H. M. Waters, K. Hyde, C. G. Geary, J. A Liu Yin

Research output: Contribution to journalArticlepeer-review

Abstract

We studied 38 patients (9 haemodialysis, 18 peritoneal dialysis, 11 advanced renal failure) over the first 12 weeks of erythropoietin therapy. In 14 iron-overloaded patients (ferritin >500 μg/l) the haemoglobin (±SEM) increased from 6.74±0.27 to 9.85±0.36 g/dl (P<0.0001) entirely by mobilizing iron reserves (reduced from 1, 220±73 to 739±111 mg, P<0.0001). In the 24 non-overloaded patients (ferritin<500 μg/l) the haemoglobin rose similarly from 7.04±0.18 to 10.70±0.36 g/dl (P<0.0001), partly from iron reserves (depleted from 200±74 to −44±77mg, P=0.016) and partly from oral iron supplements (305±110 mg). In the overloaded patients the ferritin declined from 1057 μg/l (geometric mean, range 504–3699) to 317 μg/l (42–1505, P<0.0001). In the non-overloaded patients it declined from 82 μg/l (8–461) to 45 μg/l (5–379, P=0.016). The transferrin saturation (TS) in the overloaded patients appeared to decline from 38.3±7.2% to 24.0±3.7% but this was not statistically significant. In the non-overloaded the TS was unchanged (23.3±2.4 before and 28.1±3.6% after treatment). Considering all 38 patients together, the haemoglobin correlated negatively with the ferritin (r=0.3731, P<0.001) but not with the TS. The TS correlated with the serum ferritin initially (r=0.75, P<0.001) but not after the first 4 weeks. At 12 weeks, eight of 15 patients with iron deficiency (ferritin<50 μg/l) had a TS >20%, whereas two of five patients with persistent iron overload (ferritin >500 μg/l) had a TS <20%. We conclude that (a) in patients with iron overload, stored iron is utilizable for erythropoiesis; (b) oral iron supplements are necessary and sufficient for most patients without iron overload; (c) the serum ferritin is a better indicator of iron status than the TS for renal patients on erythropoietin.

Original languageEnglish
Pages (from-to)846-853
Number of pages8
JournalNephrology Dialysis Transplantation
Volume8
Issue number9
DOIs
Publication statusPublished - 1993

Keywords

  • Erythropoietin
  • Ferritin
  • Iron stores
  • Iron supplements
  • Transferrin saturation

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