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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Iron supplements: oral iron Iron supplements: oral iron All dialysis patients should receive iron unless they have documented excessive iron stores (ferritin >800 ng/ml or transferrin saturation >50%). In predialysis patients, iron supplements (oral and/or intravenous) should be given to achieve ferritin >200 ng/ml or transferrin saturation >20%, if Hb <13g/dl in men, or 12 g/dl in women, before starting treatment with erythropoietic agents. Approx 1000 mg iron is needed in the first 3 months of EPO treatment to sustain the increase in Hb, and then approx 25–100 mg/month. Oral iron

  • Comparisons vs placebo have generally shown little benefit in increasing either ferritin or Hb.
  • Some patients respond, but many do not.
  • Most suffer GI side-effects (proportional to the dose of iron taken).
  • 200 mg elemental iron needed a day, taken between meals, and not close to oral phosphate binders.
  • Compliance is poor.
  • May cause constipation in CAPD patients (to be avoided).
  • Slow or delayed release iron more expensive and probably no more efficacious.
  • A single study comparing intravenous and oral iron in predialysis patients treated with EPO has shown equivalent effects.

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