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Very low doses of direct intravenous iron in each session as maintenance therapy in haemodialysis patients

Background: Intravenous (IV) iron supplementation is widely used in haemodialysis (HD) patients to  treat their periodic losses. However, the ideal doses and frequency is unknown. We analyse whether  treatment with 20 mg of iron IV at the end of each session of HD affects erythropoiesis activity (EA) and functional iron (FI).

Methods: In 36 patients, we measure the reticulocyte count and the content of haemoglobin reticulocyte  (CHr) as EA and FI markers respectively, before and four weeks after the end of treatment. Before the study, 23 patients received another different therapy with IV iron as maintenance therapy.

Results: Reticulocyte count was 49.7±23, 8 x103 before and 47.2±17, 2 x103 after the treatment (P=0.51). The CHr was 34.82±3,7 pg and 34.44±3.51 pg respectively (P=0.35), showing an excellent correlation with the others FI markers (serum iron r=0,6 p=0,001; saturation transferrin r=0,49 p=0,004); that is not seen with the serum ferritin (r=0.23 p=0.192) or the hepcidin (r=0.22 p=0.251). The thirteen
patients who did not receive the iron prior the study, showed a high FI levels but not an increase of the serum ferritin or the serum hepcidin.

Conclusions: The administration of a little quantity of iron at the end of every HD session keeps the EA and the FI and allows reducing the iron overload administrated and/or decreasing the iron stores markers in some patients.


Javier Deira, Silvia González-Sanchidrián, Santiago Polanco, Clarencio J. Cebrián, María C. Jiménez, Jesús P. Marín, Juan R. Gómez-Martino, Luis Fernández-Pereira and José M. Tabernero

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