Mathematical Approach for Estimating Iron Needs in Hemodialysis Patients on Erythropoietin Therapy

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Abstract
Functional iron deficiency occurs when recombinant human erythropoietin (rHuEPO) accelerates erythropoiesis to an extent that the iron availability cannot meet the anticipated demand. Such a phenomenon will reduce the optimal response to rHuEPO. To estimate the iron needs of functional iron deficiency in hemodialysis patients on rHuEPO therapy, we utilized a mathematical method. Forty hemodialysis patients were examined in the study, and all had a baseline serum ferritin (SF) level > 100 µg/l. They were stratified into patients with a transferrin saturation (TfS) value ≧ 25% (group I) and those below this value (group II). The treatment protocol consisted of rHuEPO therapy in the two groups for 6 months and iron supplement only in group II. The target hemoglobin level was 10.5 g/dl, and iron metabolism indices were analyzed prior to and following therapy. The results showed (1) in group I (n = 20) hemoglobin rose from 7.5 ± 0.9 to 10.7 ± 0.7 g/dl (p 100 µg/l and TfS ≧25%. It seems rational to provide intravenous iron in EPO-resistant patients with functional iron deficiency (SF > 100 µg/l, TfS

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