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Abstract
Anemia of chronic kidney disease (CKD)develops long before the end stage renal disease . All patients with chronic kidney disease who have haemoglobin levels lower than physiological norms are considered anaemic .
Iron deficiency is the most important cause of a suboptimal response to recombinant erythro-poietin therapy.
Both iron and erythropoietin are needed to produce red blood cells; as a result, unless adequate iron is available, Epoetin will be relatively ineffective.
In the absence of provision of supplemental iron, iron deficiency is almost always present in non transfused hemodialysis patients receiving Epoetin.
Most hemodialysis patients require IV iron to maintain sufficient iron to achieve and maintain an Hgb (Hct) of 11 to 12 g/dL (33% to 36%).
Although no tests are perfect indicators of the adequacy of iron stores, the TSAT and serum ferritin are the best measures of the body’s iron status that we currently have. The probability that iron deficiency is present increases as the values of these measures decrease.
Given the prevalence of iron deficiency in CKD patients, and the sensitivity and specificity of TSAT and serum ferritin in detection of iron deficiency, the likelihood of iron deficiency is sufficiently high when TSAT is <20% and the serum ferritin is <100 ng/mL. Therefore, the TSAT and serum ferritin should be maintained at a level of >20% and >100 ng/mL, respectively, in all patients.