HDCN Article Review/Hyperlink

Fourtounas C, Koutsikos D, Dalamangas A, et al

Supervised intradialytic oral iron administration during erythropoietin therapy

Nephrol Dial Transplant (Jul) 11:1485-1486 1996

Intravenous iron administration to hemodialysis patients is growing in popularity because it has been shown that many patients on oral iron remain iron deficient, most likely due to non-compliance. On the other hand, there remains concern that IV iron may be atherogenic, and may increase the risk of infection. The reasons for the non-compliance of course vary, and GI intolerance remains a serious problem. Dunea et al (Int J Artif Organs, 1994;17:261-264) reported that giving oral iron sulphate during dialysis under direct supervision improved patient iron stores, but his population was an inner city dialysis clinic, and hence the generalisability of his results can be called into question.

In this study from Athens, Greece, 8 patients who were not on iron supplements for 3 months, with a baseline mean serum ferritin level of 21 ug/l were begun on an intradialytic oral regimen of iron succinylate, 160 mg with each dialysis. Patients were followed for 5 weeks, while the EPO dose remained unchanged. There was a substantial increase in Hgb, from 8.8 to 9.5 g/dl, whereas the serum ferritin levels remained rather low and unchanged (pre 21, post 26 ug/L). The conclusion was, that intradialytic oral iron may be beneficial.

Comment: Of course the study has limitations, but the idea of giving iron to dialysis patients in supervised fashion by mouth at the start of a dialysis session seems to be a good one, as long as marked GI intolerance is not present. The strategy may be especially useful in patients who are noncompliant for reasons other than GI side effects. (John T. Daugirdas, M.D., University of Illinois at Chicago)