Achieving target hematocrit in dialysis patients: new concepts in iron management.
The management of anemia in dialysis patients involves a comprehensive understanding of the role of erythropoietin deficiency and of the importance of adequate available iron. It is clear that iron and recombinant human erythropoietin (rHuEPO) in concert allow the clinician to achieve a given target hematocrit in dialysis patients. By first repleting and then maintaining iron stores, and with an appreciation of the concept of functional iron deficiency, the nephrologist can achieve target hematocrits with the lowest necessary dose of rHuEPO. Iron repletion and maintenance is difficult to achieve with oral iron, and parenteral iron is needed in most cases. New protocols for ongoing parenteral maintenance therapy with iron dextran or iron gluconate, a form of iron likely to be available soon in the United States, should lead to achievement of target hematocrits in a greater number of patients and be cost-effective in improving patient outcomes.
Nissenson
A R
AR
Department of Medicine, UCLA School of Medicine, USA. anissens@medicine.medsch.ucla.edu
D000284:Administration, Oral; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004921:Erythropoietin / Q000172:deficiency / Q000627:therapeutic use; D005290:Ferric Compounds / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006400:Hematocrit; D006801:Humans; D007275:Injections, Intravenous; D007501:Iron / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007505:Iron-Dextran Complex / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011994:Recombinant Proteins; D006435:Renal Dialysis; D016896:Treatment Outcome
D005290:Ferric Compounds; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D007505:Iron-Dextran Complex; D007501:Iron; C035552:ferric gluconate