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)