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Use of iron preparations in 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 erythropoietin-stimulating agents (ESAs). Decreased iron stores or decreased availability of iron are the most common reasons for resistance to the effect of these agents.

Dialysis patients commonly suffer iron loss from gastrointestinal bleeding, blood drawing, and/or, most important with hemodialysis, the dialysis treatment itself. Hemodialysis patients lose an average of 1 to 2 g of iron per year [1]. Thus, iron deficiency will tend to develop in virtually all dialysis patients unless supplemental iron therapy is given. Based on one short-term study, there is no evidence that more frequent dialysis (ie, six times per week) results in a higher iron requirement [2].

An overview of the use of iron in patients undergoing maintenance hemodialysis is presented in this topic review. Discussions related to the use of iron in predialysis, peritoneal dialysis, and home hemodialysis patients as well as the diagnosis of iron deficiency in patients with CKD are presented separately. (See "Iron balance in nondialysis, peritoneal dialysis, and home hemodialysis patients" and "Diagnosis of iron deficiency in chronic kidney disease".)


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 must therefore include red blood cell indices, reticulocyte count, serum iron, total iron-binding capacity, percent transferrin saturation (TSAT), serum ferritin, and testing for occult blood in stool. (See "Approach to the adult patient with anemia".)

Absolute and functional iron deficiency — Although none of the routinely available tests for iron status are entirely satisfactory, among hemodialysis patients, absolute iron deficiency is likely to be present when [3,4]:


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Literature review current through: Sep 2016. | This topic last updated: Dec 16, 2015.
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