ERYTHROPOIETIN AND IRON

Careful evaluation of iron status is of pivotal importance in end-stag e renal disease patients before and during r-HuEPO therapy. Absolute ( ferritin <100 mu g/l) and functional (ferritin normal or supranormal, transferrin saturation <20%, hypochromic red blood cell [RBC] >5%) iro n deficiency are the main reasons for r-HuEPO hyporesponsiveness. Adeq uate iron supplementation allows significant reduction of r-HuEPO dosa ge and costs. Oral iron supplementation is recommended for predialysis and peritoneal dialysis patients with serum ferritin >100 mu g/l, whe reas i. v. iron supplementation is the therapy of choice in hemodialys is patients. However, neutrophil impairment and other possible side-ef fects (e. g. cardiovascular complications, malignancy) as a result of i. v. iron therapy suggest that overtreatment with i. v. iron should b e avoided.