THE USE OF IRON IN PATIENTS ON CHRONIC DIALYSIS - MISTAKES AND MISCONCEPTIONS

Anemia is the most common hematologic abnormality in patients with chr onic renal failure, The reasons for anemia in chronic renal failure ar e many and include erythropoietin and iron deficiencies, inflammation, infection, aluminum toxicity, and hyperparathyroidism. Iron deficienc y alone affects more than 50% of patients on dialysis, and the estimat ed iron loss for these patients is 1.5 to 3 grams per year. The use of erythropoietin has also uncovered iron deficiency in a multitude of p atients, Iron and erythropoietin supplementation has often restored no rmal or near-normal levels of hematocrit in these patients and has the refore improved some of the symptoms classically connected with chroni c renal failure, such as fatigue, cold intolerance, and mental sluggis hness, among others. Resistance to erythropoietin is frequently observ ed in the maintenance care for dialysis patients, and the most common reason is iron deficiency, It is important to understand the physiolog y of renal anemia, erythropoiesis and iron metabolism in order to avoi d mistakes and misconceptions in the management of iron in chronic dia lysis patients. In this article, we review several mistakes, misconcep tions, practices, and guidelines in iron supplementation therapy. We a lso review the physiology of anemia in renal disease and the importanc e of erythropoietin and iron in causing anemia and discuss recent Dial ysis Outcomes Quality Initiative (DOQI) guidelines on the topic.