The management of iron metabolism in recombinant human erythropoietin treated dialysis patients by Dutch nephrologists

Abstract

The regulation of iron metabolism is an important aspect of r-HuEPO treatment. All Dutch nephrologists involved in dialysis were asked to complete a questionnaire about iron metabolism management in dialysis patients. The response rate was 68%, covering 83% of all Dutch dialysis units. Iron status is assessed before starting r-HuEPO by 96% of the respondents, but only 58% waits for the results. Serum ferritin is determined by 98%, MCV by 77%, transferrin saturation by 44%, the percentage hypochromic red blood cells by 6%, bone marrow iron staining by 4%, and serum transferrin receptors by 0%. Serum 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% determines 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 patients by 40% of the nephrologists, 60% prescribes iron on indication. Oral substitution is preferred by 90%, but 27% incidentally prescribes intravenous iron without testing the effects of oral iron. Of all haemodialysis patients on r-HuEPO, 16% (SD 18, median 10) receives no iron substitution, 65% (+/- 28, 73) oral iron and 19% (+/- 28, 6) intravenous iron. Of all CAPD patients, 22% (+/- 24, 16) receives no iron substitution, 77% (+/- 24, 81) oral iron, and 1% (+/- 2, 0) intravenous iron. There is no communis opinio among Dutch nephrologists on the frequency of iron status assessment, the choice of parameters, the indications for iron substitution, or the decision between oral or intravenous substitution.