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Iron balance in nondialysis, peritoneal dialysis, and home hemodialysis patients

Jeffrey S Berns, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD


Patients with chronic kidney disease (CKD) are commonly iron deficient. Adequate iron stores are essential for achieving maximum benefit from erythropoietic-stimulating agents (ESAs), such as recombinant human erythropoietin (EPO) and darbepoetin alfa. Decreased iron stores or decreased availability of iron are the most common reasons for resistance to the effect of these agents.

An overview of the use of iron in nondialysis, peritoneal dialysis, and home hemodialysis patients is presented in this topic review. Discussions related to the use of iron in hemodialysis patients are presented separately. (See "Erythropoietin for treatment of the anemia of chronic kidney disease in hemodialysis patients" and "Darbepoetin alfa for the management of anemia in chronic kidney disease" and "Use of iron preparations in hemodialysis patients".)


Prior to initiating therapy, iron stores must be assessed and nonrenal causes of anemia excluded. As discussed in detail separately, the evaluation of patients with kidney disease and anemia includes red blood cell indices, reticulocyte count, serum iron, total iron-binding capacity, percent transferrin saturation (TSAT), serum ferritin, and, when appropriate, testing for occult blood in stool. (See "Approach to the adult patient with anemia".)

Absolute and functional iron deficiency — An important issue in the diagnosis of iron deficiency in the patient with chronic kidney disease (CKD) or end-stage renal disease is that the laboratory criteria are markedly different from those in patients with relatively normal renal function.

Absolute iron deficiency as determined by assessment of bone marrow iron stores is likely to be present in patients with CKD when [1]:


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Literature review current through: Sep 2016. | This topic last updated: Apr 27, 2016.
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