Background. Anaemia is a common phenomenon encountered in patients on hemodialysis. Although treatment
with rHuEPO therapy is effective, it may fail even at high doses. As rHuEPO efficacy depends on the bioavailability
of iron, we monitored the effect of consistent iron supplementation on hematocrit levels and rHuEPO dosage.
Methods and Results. 24 patients of our outpatient dialysis centre were included in this study. The mean age was
59 years. The age group over 60 included 14 patients. The mean duration of dialysis treatment was 23.8 months. The
patients were followed for 6 months according to the NKF-DOQI (National Kidney Foudantion Dialysis Outcomes
Quality Initiative) recommendations for the treatment of anaemia. Following values were examined monthly:
hematocrit, transferin saturation (TSAT) and ferritin. Iron and rHuEPO dosage was adjusted accordingly. Genetic
tests for haemochromatosis were conducted in 4 patients with the highest value of TSAT and ferritin. TSAT increased
from a mean of 15.9 % to 35.9 % (p<0.001). In 23 patients (96 %) TSAT levels were within the recommended range
after the treatment. Hematocrit increased from 27.7 % to 35.7 % (p<0.001). The recommended value of 33 % was
achieved in 18 patients (75 %). The weekly dose of eHuEPO fell from 3958 IU (International Unit) to 2042 IU
(p<0.001), i.e. 1857 IU of rHuEPO were saved per week, per patient. The average dose of iron administered was
157 mg per week. The average level of ferritin rose from 457 g/k to 1387 g/l (p<0.001). All results were comparable,
even in the group of the senior’s selected cases. Genetic testing for haemochromatosis showed mutation H63D in
heterozygous state of HFE gene in 2 of 4 patients with the highest value of TSAT and ferritin. Sufficient iron
supplementation leads to a significant rise in hematocrit and a concomitant decrease of required rHuEPO doses.
TSAT, and not ferritin, is a good marker of iron bioavailability.
Conditions. The financial savings due to decreased rHuEPO requirements are 20 times higher than the costs related
to iron supplementation, calculated in relation to prices valid for the Czech Republic in 1999. Cause and effect of
increased level of ferritin should be carefully studied.
anemia, erythropoietin, iv iron therapy, hemodialysis