EBM Question - Iron Replacement When Ferritin is High

62 yo AAF with ESRD on HD has anemia of chronic disease with Hgb 8.2 and ferritin 650. She receives EPO during HD on M/W/F. Is she a candidate for iron replacement?

Yes. According to K/DOQI guidelines, iron should not be given to dialysis if ferritin is >800 ng/ml, because it may cause iron overload (hemochromatosis). However, an increased serum ferritin is not necessarily a sign of iron overload.

What about if the ferritin is 1000?

In the previously reported cases of hemochromatosis among dialysis patients, the ferritin levels were well above 2000 ng/ml, usually in the 3000–10 000 ng/ml range.

According to a recent study, K/DOQI guidelines may not be appropriate and may deprive these possibly inflamed but not iron-overloaded patients of required iron. The study authors suggest a new cut-off point (>2000) above which supplemental iron should not be given.

Nephrol Dial Transplant. 2004, Semin Dial. 2004
K/DPQI is Kidney Disease Outcome Quality Initiative

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