MANAGEMENT OF IRON-DEFICIENCY IN RENAL ANEMIA - GUIDELINES FOR THE OPTIMAL THERAPEUTIC APPROACH IN ERYTHROPOIETIN-TREATED PATIENTS

Much progress has been made in recent years in the management of anemi a associated with chronic renal failure with recombinant human erythro poietin (r-Hu EPO). However, there remains much debate surrounding the diagnosis and treatment of iron deficiency. To ensure that full benef it from erythropoietin therapy is received, most patients require iron supplement during treatment. There are, however, few guidelines for t he use of iron therapy. Iron deficiency results in an inadequate respo nse to r-Hu EPO and is the main cause of resistance to this treatment. Oral iron therapy is of limited value in patients receiving r-Hu EPO. Thus, intravenous iron supplementation should be administered only in patients who do not tolerate available intravenous iron preparations or who are on continuous ambulatory peritoneal dialysis with no eviden ce of functional iron deficiency. This article provides guidelines for the diagnosis of absolute or functional iron deficiency in patients w ith renal anemia and suggests treatment schedules for intravenous iron supplementation. We hope that all dialysis patients will be able on t his basis to achieve a satisfactory iron status and benefit fully from r-Hu EPO therapy.