Short-term small-dose intravenous iron trial to detect functional iron deficiency in dialysis patients

Background/Aim: Management of renal anemia in endstage renal disease requir es careful evaluation of the iron status before and in particular during er ythropoietin treatment. However, there is no simple and practical iron inde x accurately predictive of functional iron deficiency in these patients til l now. The purpose of this prospective study, therefore, is to evaluate whe ther a short course of low-dose intravenous iron challenge can detect funct ional iron deficiency in hemodialysis patients. Methods: Twenty-four patien ts with baseline serum ferritin levels between 100 and 500 ng/ml were treat ed with intravenous saccharated ferric oxide, 960 mg over 24 hemodialysis t reatments, and the hemoglobin level was checked every week. Results: Patien ts whose hemoglobin value increased at least by 1 g/dl within the 8-week pe riod were classified as having functional iron deficiency or as responders (n = 26; 81.2%). All other subjects were classified as having adequate iron levels or as nonresponders (n = 6; 18.8%). There were no significant diffe rences in age, sex, dialysis years, KtV/, dialyzers, hemoglobin, and basal and final trasferrin saturation and ferritin between responders and nonresp onders. In addition, there were no iron indices with acceptable levels of s ensitivity and specificity. On the contrary, the cutoff value of increments of hemoglobin of at least 0.2 g/dl after a 2-week intravenous iron trial h ad a sensitivity of 96.2% and a specificity of 100% in all patients (n = 32 ) and a sensitivity of 100% and a specificity of 100% after patients with t ransferrin saturation < 20% were excluded (n = 24). These values had the gr eatest utility of the tests studied in this work. Conclusion: A 240-mg intr avenous iron challenge during a 2-week period may be a simple, accurate, an d straightforward method to detect a functional iron deficiency status in h emodialysis patients undergoing erythropoietin therapy. Copyright (C) 2001 S. KargerAG, Basel.