An Indistinct Balance

Publisher Website
Google Scholar
Abstract
The NKF-DOQI Anemia Work Group guidelines support the implementation of a proactive intravenous iron maintenance regimen. Given that gastrointestinal iron absorption is less than ongoing iron losses in the majority of hemodialysis (HD) patients, functional iron deficiency is likely to develop in most patients leading to an iron-limited erythropoiesis. We define functional iron deficiency as a pathophysiologic state in which the bone marrow's erythropoietic capacity to respond to epoetin is limited by iron release from storage depots. The result of such deficiency is utilization of higher and more costly doses of epoetin to overcome what is errantly perceived as relative resistance to epoetin. Parenteral iron is the treatment of choice in HD patients with either absolute or functional iron deficiency since oral iron therapy is nearly always ineffective in the dialysis population. In fact, the NKF-DOQI guidelines advocate aggressive detection and management of functional iron deficiency. An initial and careful scrutiny of the iron status of the dialysis patient is succeeded by the optimized delivery of parenteral iron and epoetin to achieve the desired level of erythropoiesis.

This publication has 0 references indexed in Scilit: