Erythropoietin and iron.
Careful evaluation of iron status is of pivotal importance in end-stage renal disease patients before and during r-HuEPO therapy. Absolute (ferritin < 100 micrograms/l) and functional (ferritin normal or supranormal, transferrin saturation < 20%, hypochromic red blood cell [RBC] > 5%) iron deficiency are the main reasons for r-HuEPO hyporesponsiveness. Adequate iron supplementation allows significant reduction of r-HuEPO dosage and costs. Oral iron supplementation is recommended for predialysis and peritoneal dialysis patients with serum ferritin > 100 micrograms/l, whereas i.v. iron supplementation is the therapy of choice in hemodialysis patients. However, neutrophil impairment and other possible side-effects (e.g. cardiovascular complications, malignancy) as a result of i.v. iron therapy suggest that overtreatment with i.v. iron should be avoided.
Sunder-Plassmann
G
G
Department of Medicine, University of Vienna, Austria.
Hörl
W H
WH
D000535:Aluminum / Q000097:blood; D004791:Enzyme Inhibitors / Q000097:blood; D004912:Erythrocytes / Q000378:metabolism*; D004921:Erythropoietin / Q000191:economics / Q000627:therapeutic use*; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism / Q000627:therapeutic use*; D000090463:Iron Deficiencies; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D011524:Protoporphyrins / Q000097:blood; D011994:Recombinant Proteins; D014168:Transferrin / Q000378:metabolism
D004791:Enzyme Inhibitors; D006454:Hemoglobins; D011524:Protoporphyrins; D011994:Recombinant Proteins; D014168:Transferrin; D004921:Erythropoietin; C017803:zinc protoporphyrin; D005293:Ferritins; D000535:Aluminum; D007501:Iron