Received January 24, 2007
Accepted on April 25, 2007

ORIGINAL ARTICLES

Role of Oral Iron in the Management of Long-Term Hemodialysis Patients

Ilan Lenga ^*, Charmaine Lok , Rosa Marticorena , Joyce Hunter , Niki Dacouris , and Marc Goldstein ¹

*Lakeridge Health Corporation, Oshawa, and University Health Network and Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada

¹ To whom correspondence should be addressed. E-mail: marc.goldstein{at}utoronto.ca.

	Abstract

The literature contends that oral iron supplementation is relatively ineffective in patients who are on long-term hemodialysis (HD), and intravenous iron is the superior form of supplementation. Data were prospectively abstracted from a cross-sectional cohort of all patients in the long-term in-center HD program at St. Michael’s Hospital (SMH) from April 1, 2003, to April 1, 2004. Laboratory data were measured monthly. SMH data were compared with those in eight other centers in the Toronto Region Dialysis Registry. A total of 93% of the 151 patients tolerated oral iron. Eighty-eight (58%) patients received oral iron exclusively, and 60 (40%) patients received intravenous iron with or without oral iron. Of the patients who received oral iron exclusively, 73% maintained a hemoglobin of 110 g/L and 93% maintained a hemoglobin of 100 g/L. A total of 74% had an iron saturation 20%, and 36% had a ferritin level >100 g/L. Among the patients who were on oral iron alone and had hemoglobin of 110 g/L, the same amount of erythropoietin was used regardless of ferritin levels (P = 0.17), but less erythropoietin was used when they reached the target for either iron saturation or both iron indices (P = 0.02 and 0.03, respectively). Among the centers in the Toronto Region Dialysis Registry, hemoglobin levels and erythropoietin dosages did not differ among the three centers that predominantly used oral iron versus the six centers that predominantly use intravenous iron (P = 0.46 and 0.95, respectively). Oral iron is a well-tolerated and effective form of iron supplementation in long-term HD patients.