title: Do iron guidelines translate into good clinical practice for patients on haemodialysis?
abstract: BACKGROUND
  Patients on haemodialysis (HD) have greater iron needs than the normal population. In 2004, the Caring for Australasians with Renal Impairment (CARI) group audited six Australian renal centres and found considerable variability in achievement of iron and haemoglobin targets.
  
  
  OBJECTIVE
  The aim of this study was to determine whether intravenous iron guidelines and evidence translate into good clinical outcomes for patients on HD.
  
  
  METHODS
  Data were extracted from the Renal Anaemia Management database for the period of 2007-2009. These data were compared with the target levels described in the CARI guidelines.
  
  
  RESULTS
  Most patients were not achieving recommended haemoglobin, ferritin or transferrin saturation levels. Australian Aboriginal and Torres Strait Islander people were less likely to achieve targets.
  
  
  CONCLUSIONS
  Iron guidelines are not translating into good clinical practice for patients on HD. This situation may be improved by updating the CARI guidelines (as has recently been carried out for haemoglobin targets), introduction of more consistent dosing protocols across hospitals and greater assessment of safe levels of cumulative iron and ferritin.
authors.affiliation: Renal Care, Dialysis Unit, St Vincent's Hospital, Melbourne, VIC, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Morris
authors.forename: Marianne
authors.initials: M
authors.lastname: Snedeker
authors.forename: Gail
authors.initials: G
authors.lastname: Reed
authors.forename: Belinda
authors.initials: B
authors.lastname: Butcher
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bradley
mesh_terms: D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000517:prevention & control; D001315:Australia; D054869:Clinical Audit; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D058085:Iron Compounds / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D006435:Renal Dialysis; D014168:Transferrin / Q000378:metabolism
chemical_list: D006454:Hemoglobins; D058085:Iron Compounds; D014168:Transferrin; D005293:Ferritins
keywords: Clinical guidelines; Haemodialysis; Iron