ESTIMATION OF DIFFERENT LABORATORY PARAME TERS FOR VALUATION OF IRON-METABOLISM IN HEMODIALYSIS-PATIENTS

In hemodialysis patients (HD) for the treatment of anemia estimation o f iron balance is very important. There are discrepant opinions regard ing the value of zinc protoporphyrin (ZPP), the percentage of hypochro mic red blood cells (%Hypo), serum ferritin (SF) and transferrin satur ation (TFS) with respect to aluminum (Al) overloading. We estimated in 77 HD (56 +/- 16 years) the parameter SE TFS, %Hypo and ZPP monthly d uring a 6-month period without iron therapy and after a 4-month period with iron therapy. The second period was firstly started with a iron test dosis of 125 mg i.v. 43 HD were treated by rhEPO with a stable do sage during 10 months. Desferrioxamin(DFO)-test were carried out at th e beginning, after 6 months and at the end of the study. During the pe riod without iron therapy 63 HD (81.8%) developed a manifest iron defi ciency documented by significant increase of %Hypo (1.49% to 3.50%), Z PP (96 to 104 mu mol/mol heme) and decrease of the SF (846 to 502 mu g /l) and TFS (30.1% to 16.4%). The increase of %Hypo was obvious in iro n deficiency and in Al-overloading too (p < 0.01). A bolus application of 125 mg iron i.v. yielded an increase of %Hypo (108% after 1 week) and obviously significant (p < 0.01) correlation regarding (r = 0.88) the increase of hemoglobin during iron therapy. ZPP gave no evidence i n diagnosis of iron deficiency in renal anemia. %Hypo seems to be a mu ch more potent predictor value assuming that an Al-overload is exclude d.