Iron metabolism in haemodialysis patients. A study of the management of iron therapy and overload
Gokal, R.; Millard, P.R.; Weatherall, D.J.; Callender, S.T.; Ledingham, J.G.; Oliver, D.O.
Quarterly Journal of Medicine 48(191): 369-391
1979
ISSN/ISBN: 0033-5622 PMID: 542584 Document Number: 144781
Some dialysis units replace iron losses in patients on maintenance haemodialysis (MHDT) with parenteral iron because of doubts about adequate intestinal Fe absorption. This can lead to Fe loading. Of 120 MHDT patients 64 had serum ferritin values above 1000 mu g/litre and there was good correlation between these values and the number of years on dialysis. A retrospective study of 22 MHDT patients post mortem showed significant amounts of Fe in liver and spleen and in 5 there was myocardial Fe loading. Five MHDT patients with Fe loading were given desferrioxamine by vein at dialysis. Fe was chelated but with some difficulty. Fe absorption, using 59Fe and the total body counter, was similar in the MHDT patients with Fe deficiency (mean plus or minus s.e. mean 42.5 plus or minus 5.8%) and iron-deficient subjects without renal disease (45.3 plus or minus 1.86%). In iron-replete MHDT patients Fe absorption (8.1 plus or minus 2.6%) did not differ significantly from normal controls (14.9 plus or minus 1.6%) but it was reduced in iron-loaded MHDT patients (5.4 plus or minus 0.7%). There was good correlation between red cell indices and Fe stores in MHDT patients, and haemoglobin values in 15 iron-deficient MHDT patients rose significantly on treatment with Fe by mouth. These findings indicate that the control mechanisms which relate Fe absorption to body Fe stores are intact in patients on MHDT. Treatment with Fe by mouth is recommended and can be monitored using red cell indices. Prolonged parenteral Fe treatment is unnecessary and potentially dangerous.