Iron Metabolism in Haemodialysis PatientsA STUDY OF THE MANAGEMENT OF IRON THERAPY AND OVERLOAD

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Abstract
Some dialysis units replace iron losses in patients on maintenance haemodialysis treatment (MHDT) with parenteral iron because of doubts about adequate intestinal iron absorption. Recent experiences in Oxford indicate that this can lead to potentially dangerous iron loading. Sixty-four of 120 MHDT patients had serum ferritin levels >1000 μg/l and there was a good correlation between these levels and the number of years on dialysis. A retrospective post-mortem study of 22 MHDT patients showed significant amounts of iron in liver and spleen and in five cases there was myocardial iron loading. Five MHDT patients with iron loading were given desferrioxamine intravenously at dialysis. Iron was chelated but with some difficulty. Iron absorption, using 59Fe and the total body counter, was found to be similar in both the MHDT patients with iron deficiency (mean ± S.E.M.; 42·5 ± 5·8 per cent) and iron deficient subjects without renal disease (45·3 ± 1·86 per cent). In iron replete MHDT patients iron absorption (8·1 ± 2·6 per cent) did not differ significantly from normal controls (14·9 ± 1·6 per cent) while it was reduced in iron loaded MHDT patients (5·4 ± 0·7 per cent). There was a good correlation between red cell indices and iron stores in MHDT patients and haemoglobin values in 15 iron deficient MHDT patients rose significantly when treated with oral iron. These findings indicate that the control mechanisms which relate iron absorption to body iron stores are intact in patients on MHDT. Oral iron therapy is recommended and can be monitored using red cell indices. Prolonged parenteral iron treatment is unnecessary and potentially dangerous.

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