AN EVALUATION OF THE EFFECTIVENESS OF ORAL IRON THERAPY IN HEMODIALYSIS-PATIENTS RECEIVING RECOMBINANT-HUMAN-ERYTHROPOIETIN

Iron balance is critical for adequate erythropoiesis in hemodialysis p atients treated with recombinant human erythropoietin (EPO). The role of oral iron therapy in maintaining or replenishing iron stores has no t yet been well defined in such patients. We undertook a double-blind, placebo-controlled study to evaluate the efficacy of oral iron in 49 hemodialysis patients, divided into two groups, based on adequate or d eficient iron stores. These groups were treated for 3 months with 150 mg elemental iron (Polysaccharide complex, Central Pharmaceuticals) or placebo, twice daily. Laboratory parameters were followed for five mo nths. These parameters included: hematocrit (Hct), ferritin, transferr in saturation (Tsat), and zinc protoporphyrin (ZPP). A side-effects qu estionnaire was recorded monthly. Our results indicate that iron reple te patients show evidence of falling iron stores during the study peri od; this observation was identical in both oral iron and placebo subgr oups. Iron deficient patients had a significantly greater drop-out rat e due to side effects when compared to iron replete patients (33% vs. 8%), despite equivalent responses to the side-effect questionnaire. We conclude: 1) Oral iron fails to maintain iron stores in iron replete patients; 2) Iron deficiency observed in this study may be due to poor medication compliance rather than side-effects.