Maintaining higher TSATs and other iron indices is beneficial in management of anemic hemodialysis patients.
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative and other groups support maintaining transferrin saturation (TSAT) levels above 20% and serum ferritin levels above 100 ng/ml to ensure adequate erythropoiesis in hemodialysis patients receiving erythropoietin. However, researchers have found that even patients with TSATs above 20% may still have functional iron deficiency. This article presents information that supports the fact that maintenance of TSATs between 30% and 50%, through the use of continuous intravenous iron therapy, results in improvement of anemia, reduction in erythropoietin dose requirements, and an increase in the reticulocyte hemoglobin content. The implications of these findings for clinical practice are also discussed.
Besarab
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West Virginia University School of Medicine, Dialysis Unit, Ruby Memorial Hospital, Morgantown, WV, USA.
Dalton
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D000465:Algorithms; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D002985:Clinical Protocols; D003663:Decision Trees; D016903:Drug Monitoring / Q000379:methods* / Q000451:nursing / Q000592:standards; D004921:Erythropoietin / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007505:Iron-Dextran Complex / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods* / Q000451:nursing / Q000592:standards; D017749:Total Quality Management; D014168:Transferrin / Q000378:metabolism*; D016896:Treatment Outcome
D014168:Transferrin; D004921:Erythropoietin; D007505:Iron-Dextran Complex; D005293:Ferritins