title: Monitoring of iron requirements in renal patients on erythropoietin.
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 micrograms/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 micrograms/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 +/- 77 mg, P = 0.016) and partly from oral iron supplements (305 +/- 110 mg). In the overloaded patients the ferritin declined from 1057 micrograms/l (geometric mean, range 504-3699) to 317 micrograms/l (42-1505, P < 0.0001). In the non-overloaded patients it declined from 82 micrograms/l (8-461) to 45 micrograms/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.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Renal Medicine, Manchester Royal Infirmary, UK.
authors.forename: E G
authors.initials: EG
authors.lastname: Anastassiades
authors.forename: D
authors.initials: D
authors.lastname: Howarth
authors.forename: J
authors.initials: J
authors.lastname: Howarth
authors.forename: D
authors.initials: D
authors.lastname: Shanks
authors.forename: H M
authors.initials: HM
authors.lastname: Waters
authors.forename: K
authors.initials: K
authors.lastname: Hyde
authors.forename: C G
authors.initials: CG
authors.lastname: Geary
authors.forename: J A
authors.initials: JA
authors.lastname: Yin
authors.forename: R
authors.initials: R
authors.lastname: Gokal
mesh_terms: D000328:Adult; D000368:Aged; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000378:metabolism*; D007674:Kidney Diseases / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D014168:Transferrin / Q000378:metabolism
chemical_list: D014168:Transferrin; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron