Role of oral iron in the management of long-term hemodialysis patients

Background: 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. Design, setting, participants, and measurements: 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. Results: 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). Conclusions: Oral iron is a well-tolerated and effective form of iron supplementation in long-term HD patients.