title: Upper limit of serum ferritin: misinterpretation of the 2006 KDOQI anemia guidelines.
abstract: Intravenous iron treatment in hemodialysis patients improves response to recombinant human erythropoietin and facilitates achievement of targets for hemoglobin and hematocrit. Excessive treatment, however, could expose patients to risks related to iron overload and oxidative stress. Therefore, international treatment guidelines generally recommend that intravenous (i.v.) iron be discontinued when serum ferritin is >500-1,000 ng/ml. In the current review, relevant issues that inform decisions as to what levels of serum ferritin should be used as the upper limit for treatment are considered. A conclusion is reached that the current published literature is inadequate for developing evidence-based guidelines on this issue. Instead, clinical judgment is critical to properly weigh risks and benefits of i.v. iron treatment, and to determine whether iron treatment is appropriate for a given patient with higher levels of iron tests.
authors.forename: Steven
authors.initials: S
authors.lastname: Fishbane
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D004921:Erythropoietin / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood*; D019983:Guideline Adherence; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects
chemical_list: D006397:Hematinics; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron