Effectiveness of erythropoiesis on supervised intradialytic oral iron and vitamin C therapy is correlated with Kt/V and patient weight

Background: Poor compliance to oral medication and diet is common in hemodi alysis (HD) patients and limits the ability of oral iron therapy to support erythropoiesis. Intravenous (i.v.) iron may be associated with undesirable and sometimes life-threatening complications. Patients and methods: We hyp othesized that intradialytic oral iron therapy can overcome compliance prob lems and support effective maintenance erythropoiesis, which will keep Her in the range of 33% to 36% and EPO requirements up to 50 units/week/kg. In a prospective observational study. SC EPO-treated hospital-based HD patient s without conditions known to cause EPO resistance, were managed on intradi alytic oral administration of iron and vitamin C, The primary endpoints wer e EPO requirements and resistance to EPO which standardized EPO requirement s by the Hct level. Secondary endpoints included parameters that might affe ct the primary endpoints. Exclusion criteria were refusal to take oral medi cation. prestudy Hct < 27%, recent i.v. iron therapy or transfusions, bleed ing, clinical conditions obligating Hct > 30% and known causes of EPO resis tance. Twelve patients completed minimal follow-up period of 9 months. Resu lts: Mean Hct was 34.4% (range: 31.8% - 40.2%). EPO requirements were 61.7 +/- 28.2 units/kg and below 52.5 units/kg in 50% of patients. Patients were classified into equal groups according to resistance to EPO, which was pos itively correlated (r = 0.71 p < 0.01) with body weight and Kt/V (r = -0.38 , p < 0.05). Conclusion: In conclusion, intradialytic oral iron therapy can support effective maintenance erythropoiesis in 50% of patients without kn own causes for EPO resistance, High response to EPO and low EPO requirement are correlated with lower body weight and possibly improved dialysis.