I get IV iron 1x a month at my clinic visit. By mid month, my iron sat has dropped to around 21. DOQI Guidelines recommends that iron sat be 25 or higher. My ferritin is currently high at 1100. With #'s like this, am I getting iron often enough, enough at a time etc. to keep the correct balance between epo/ iron for a good hgb? My hgb has been consistently good and I am on a very low dose of epo, but I wonder if it sounds like everything is being managed properly? I know there are some home patients who no longer require any epo at all.
On my end, regardless how the iron is they won’t let HGB be more than 12
It’s possible that the reason your iron saturation is low and your ferritin is high is related to inflammation which could be assessed by doing a blood test for C-reactive protein to see if it’s 10 mg/L or higher. If so, with treatment of the inflammation, it’s possible that your anemia can be managed with lower doses of ESAs and iron. Here’s an abstract that might interest you:
Thanks very much for the article Beth. I’ve been waiting a long time for someone to begin answering my questions on this issue I have. I’ve asked about this iron situation at other sites and not one person understands the subject. The article is very technical. All I can make out of it is it seems to say, get rid of the inflammation and you’ll improve your anemia management. My anemia management is pretty good at the moment despite an iron sat below 25%. I am on a very small dose of epo. If I did not have this issue maybe I’d be off of epo altogether. It concerns me more that my ferritin has been high for weeks after getting IV iron 1x a month for a few months. I have not had to get IV iron for 3 or 4 months now as my ferritin has hoovered at around the 1200 mark all this time. Iron sat is not 25%, but has not been below 19%.
My neph did tell me one time that the issue I have is probably due to inflammation. He said all dialysis patients have inflammation, but he didn’t explain it well or give me any steps to take. My neph, and all the previous ones I’ve had, most often gives me answers like this. When I get this kind of answer I feel he doesn’t understand it himself or can’t communicate it in a way that I can understand. None of the nurses understand it. You would think working in dialysis they would understand basic info like this. The dietitian is also unknowledgable on this subject. This has been my experience the whole time I have been on dialysis. I get little education from my team and have to go elsewhere for answers. Crazy isn’t it?
I don’t have the time in a day to search for answers my team should know. But I guess my next step is to research inflammation. I often come to dead ends though when reading articles as they are so technical and then if I have a question, I’m back to zero again with no one having the answer lol! It’s a never ending battle, but thanks for steering me in the right direction. Could you add iron issues/anemia management to the Webinar docket : )
I think I posted this article before. I didn’t search to see if it’s in this or a different thread. Table 3 in this article provides a list of possible causes of inflammation in people on dialysis. The article discusses in very medical (and scary) terms the risks of inflammation including malnutrition and cardiovascular problems. It also discusses possible treatments for inflammation on page 12. I suspect that the renal community has become complacent about inflammation (just like it’s complacent about the symptoms patients experience on in-center HD) figuring that’s the way things are with dialysis patients. In my opinion, more research needs to be done on treatments to prevent or reduce inflammation to lower the risks of bad outcomes.
I recall this article now and I’m the one you looked it up for. I haven’t gotten back to it yet as I’ve been tackling other things lately. My main thrust has been to get to nocturnal txs and along the way every chance I have had I have cleared up one tx issue after another. I didn’t realize just how important this issue might be as my team always acts like it’s just something dialysis patients must live with. I just went to the article but don’t see a p.12. All the page #s are in the 800’s. Is there something I need to click on to get to it?
Sorry about that…The table of possible causes of inflammation are on page 869 of the article (page 6 of the 18 page PDF) and there is a list of possible treatments on page 875 of the article (page 12 of the 18 page PDF). The management section starts on page 873.
Ok thanks. I’m about out of study time for today, but will get to it tomorrow. Today I found a video on access care and now I’m trying to figure out how I can locate the Dr. in the video, Dr. George Kontos, Illinois. who has a special procedure to keep fistulas open and reduce access failures. I would like to be able to locate other access care centers that do this type of access preventative maintenance in order to get educated on how I can put together an access care plan. It never ends : )