INTRADIALYTIC ORAL IRON THERAPY

In order to test the limits of what can be achieved with oral iron therapy and eliminate the factor of noncompliance, we conducted a series of observational studies in an 140-patient inner city dialysis unit. In these studies the patients received supervised iron therapy as 3-4 ferrous sulfate (325 mg) tablets during each dialysis. Acceptance and tolerance was high, less than 10% refusing to take the tablets. In two separate observational studies oral intradialytic iron yielded a hematocrit 28% in 69% of patients and 30% in 42-52%. There was no correlation between the final hematocrit and serum ferritin or transferrin saturation. The response to iron therapy could frequently not be predicted by the ferritin levels or transferrin saturation. We conclude that in view of the known hazards of intravenous iron dextran, oral intradialityc therapy should be tried first and that a good response can be expected in one half to two thirds of hemodialysis patients.