on the correction of anaemia with epoetin [3], iron Results deficiency, whether absolute or functional, was clearly implicated as the major factor responsible for a subKey points from the EBPG optimal response to epoetin therapy [4]. Conversely, inadequate iron stores may result in higher dose $ All chronic renal failure patients must be iron requirements of epoetin as physicians strive to achieve replete to achieve and maintain the target the target haemoglobin. haemoglobin (Hb). Although no definitive test is available, iron $ Adequate iron status is defined as: serum ferritin deficiency or iron overload commonly are measured 100 mg/l, hypochromic red cells 20%]. To achieve these as an index of iron stores, and/or the percentage of targets, the population medians will be: serum hypochromic red cells in circulation (as an index of ferritin 200–500 mg/l and hypochromic red cells the availability of these stores) [1]. Since the required 20%). iron deficiency. Optimal levels are defined as: serum ferritin of $ 41% of patients receiving epoetin in the correction 200–500 mg/l with hypochromic red cells <2.5% (or phase had iron stores monitored less frequently TSAT of 30–40%). Two additional categories of iron than is recommended by EBPG. status were also used for the ESAM analysis: (i) $ Almost 19% of haemodialysis and 34% of periabsolute iron deficiency: serum ferritin <100 mg/l; and toneal dialysis patients received no iron (ii) functional iron deficiency: serum ferritin 100 mg/l supplementation during the 6-month study. and TSAT <20%. $ Of those patients with absolute iron deficiency receiving no iron supplementation in the first month of the study, 60.4% were still receiving no The prevalence of iron deficiency iron 5 months later. $ In haemodialysis patients, both the mean haemoWhile 15.3–21.7% of haemodialysis patients were clasglobin levels and the epoetin dose required to sified as having absolute iron deficiency, the percentage achieve these haemoglobin levels were significantly of peritoneal dialysis patients with absolute iron defidifferent across the three categories of iron status; ciency in any given month ranged from 40.9 to 44.5%. patients with adequate iron status reached a higher Table 14 shows monthly iron status for haemodialysis haemoglobin level with a lower epoetin dose. and peritoneal dialysis patients in the maintenance phase of epoetin therapy. Between 57.5 and 64.6% of The role of iron is crucial to red cell production and to the epoetin response, as the need for available iron haemodialysis patients had an adequate iron status in any given month, while 45.0–49.5% of peritoneal is increased due to enhanced erythropoietic activity [1,2]. While underdialysis ( Kt/V <1.2) and poor dialysis patients had an adequate iron status. Given the importance of serum ferritin as a marker nutritional status (based on low serum albumin concentrations) were identified in the 1997 ESRD Core of iron deficiency, we examined the distribution of month 6 serum ferritin levels for haemodialysis and Indicators Project paper as having a negative impact