Iron Balance in Hemodialysis Patients

Abstract

Fe deficiency is a frequent complication in chronically hemodialyzed patients because of the significant blood losses associated with this technique. Quantitating Fe stores (by marrow examination or serum Fe and total Fe-binding capacity) on a repetitive basis was difficult or unreliable, often resulting in failure to recognize Fe deficiency superimposed on the existing anemia of chronic renal failure, or overtreating, which can lead to Fe excess. Use of the serum ferritin allows easier quantitation of Fe stores and, when measured serially in dialysis patients, can predict the emergence of Fe deficiency. There was not correlation between serum ferritin levels and serum Fe, total Fe-binding capacity or percent transferrin saturation. Fe absorption studies show that food Fe absorption is physiologic, increasing when the serum ferritin is below 30 ng/ml, decreasing when more than 300 ng/ml. Treatment of Fe deficiency with Fe compounds increases serum ferritin levels and usually can maintain Fe balance.