Iron deficiency in patients with renal failure

The anemia of renal failure is caused by the lack of sufficient quantities of endogenous erythropoietin. With the availability of recombinant human er ythropoietin (rHuEPO), however, it has become apparent that to achieve a gi ven target, hematocrit requires proper management of iron replacement, as w ell as the administration of rHuEPO. Iron deficiency, either absolute or fu nctional, will occur in most, if not all, patients on hemodialysis receivin g rHuEPO because of the increased demand for iron driven by the accelerated erythropoiesis that occurs with exogenous rHuEPO administration, coupled w ith ongoing blood losses from dialyzer and tubing, blood sampling, gastroin testinal blood loss, and blood losses at the time of dialysis needle placem ent and removal. Blood loss is less of a problem in patients on peritoneal dialysis, but poor iron intake and increased demand for iron are also seen, the latter in patients receiving rHuEPO. It is essential, therefore, for r enal health professionals to understand iron metabolism in dialysis patient s in order to properly balance the therapy of renal anemia with rHuEPO and supplemental iron.