THE MANAGEMENT OF IRON-METABOLISM IN RECOMBINANT-HUMAN-ERYTHROPOIETINTREATED DIALYSIS PATIENTS BY DUTCH NEPHROLOGISTS

Background. The regulation of iron metabolism is an important aspect o f r-HuEPO treatment. Method. All Dutch nephrologists involved in dialy sis were asked to complete a questionnaire about iron metabolism manag ement in dialysis patients. Results. The response rate was 68%, coveri ng 83% of all Dutch dialysis units. Iron status is assessed before sta rting r-HuEPO by 96% of the respondents, but only 58% waits for the re sults. Serum ferritin is determined by 98%, MCV by 77%, transferrin sa turation by 44%, the percentage hypochromic red blood cells by 6%, bon e marrow iron staining by 4%, and serum transferrin receptors by 0%. S erum ferritin is considered to be the most important parameter by 48%, transferrin saturation by 37%, percentage hypochromic red blood cells and serum transferrin receptors by 0%. Of the respondents, 17% determ ines iron status twice a year, 13% three times, 54% four times, 4% six times, 4% eight times, and 8% twelve times. Iron is given to all pati ents by 40% of the nephrologists, 60% prescribes iron on indication. O ral substitution is preferred by 90%, but 27% incidentally prescribes intravenous iron without testing the effects of oral iron. Of all haem odialysis patients on r-HuEPO, 16% (SD 18, median 10) receives no iron substitution, 65% (+/-28, 73) oral iron and 19% (+/-28, 6) intravenou s iron. Of all CAPD patients, 22% (+/-24, 16) receives no iron substit ution, 77% (+/-24, 81) oral iron, and 1% (+/-2, 0) intravenous iron. C onclusion. There is no communis opinio among Dutch nephrologists on th e frequency of iron status assessment, the choice of parameters, the i ndications for iron substitution, or the decision between oral or intr avenous substitution.