title: Attitude of physicians towards iron supplementation in hemodialysis patients treated with erythropoietin.
abstract: This study was performed to evaluate the attitude of the physicians in Saudi Arabia towards iron supplementation in hemodialysis patients treated by recombinant human erythropoietin (r-HuEPO). A questionnaire was sent to 174 physicians in the 133 active dialysis centers in Saudi Arabia; 99 (74.5%) centers in Ministry of Health (MOH), 14 (10.5%) in governmental non-MOH institutions and 20 (15%) in the private sector, who collectively looked after more than 7300 chronic hemodialysis patients of whom 4745 (65%) were on erythropoietin therapy. A total of 149 out of 174 (85.6%) physicians answered the questionnaire. Of them, 90 (60.4%) had a protocol for intravenous (i.v.) iron administration, 117 (78.5%) utilized serum ferritin and 75 (50.3%) utilized transferrin saturation (TS) ratio for the evaluation of iron stores in their patients. There were 97 respondents (88%) who would initiate i.v. iron during the induction therapy of r-HuEPO in case of absolute iron deficiency, 44 (54.3%) in case of borderline iron deficiency, 38 (48.1%) in case of functional iron deficiency and only eight (10.6%) in case the values of the ferritin and TS were higher than normal. There were 100 respondents (76.3%) who believed that i.v. iron supplements could decrease the dose of r-HuEPO and 123 (91.1%) believed that i.v. iron could improve the hematocrit response to r-HuEPO. Furthermore, there were 95 (87.2%) respondents who would use iron saccharate as the iron preparation of choice, 70 (52.2%) believed that iron saccharate caused less hypersensitivity than iron dextran while 84 (75%) had no idea about the cost of i.v. iron preparations. There were 74 (55.6%) respondents who would administer high iron loading dose over a short period and 87 (66.9%) would follow the guidance of the lab tests during the maintenance phase of the r-HuEPO replacement therapy. Our study suggests that a protocol for i.v. iron supplementation is lacking in many centers. There is a need to increase awareness of the physicians working in those centers to the importance of i.v. iron therapy.
authors.affiliation: Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia.
authors.forename: Muhammad Ziad
authors.initials: MZ
authors.lastname: Souqiyyeh
authors.forename: Faissal Am
authors.initials: FA
authors.lastname: Shaheen