Iron supplementation therapy seems almost indispensable in adequate management of the patients with end -
stage renal disease on maintenance hemodialysis, since at least one and a half grams iron is considered to be required per
year to keep sufficient erythropoiesis. Iron supplementation in conjunction with erythropoietic-stimulating agents is
widely carried out as a standard therapy. However, definite diagnosis of iron deficiency in hemodialysis patients is often
difficult since serum ferritin levels increase frequently by various reasons including inflammation and malignancy.
Although several guidelines to treat anemia of the hemodialysis patients have been proposed, they seem still insufficient
and careful clinical observation is required in individual patient to avoid possible complications of iron overload. We,
here, reassess the adequate iron supplementation therapy in those patients, and the necessity of new guideline employing
recent advances including magnetic resonance imaging – based method (FerriScan) and hemoglobin content per each
reticulocyte is also discussed.
Keywords: Erythropoietic-stimulating agents, end-stage renal disease, ferritin, iron, hemodialysis, iron deficiency, iron
supplementation, iron overload.
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