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Part 7: Nutrition in PD |
Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
Correspondence to: D.W. Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia. david_johnson{at}health.qld.gov.au
Iron supplementation is required in a preponderance of peritoneal
dialysis (PD) patients treated with erythropoietic stimulatory agents (ESAs).
Although many authors and clinical practice guidelines recommend primary oral
iron supplementation in ESA-treated PD patients, numerous studies have clearly
demonstrated that, because of a combination of poor bioavailability of oral
iron, gastrointestinal intolerance, and noncompliance, oral iron
supplementation is insufficient for maintaining a positive iron balance in
these patients over time. Controlled trials have demonstrated that, in
iron-deficient and iron-replete PD patients alike, intravenous (IV) iron
supplementation results in superior iron stores and hemoglobin levels with
fewer side effects than oral iron produces. Careful monitoring of iron stores
in patients receiving IV iron supplementation is important in view of
conflicting epidemiologic links between IV iron loading and infection and
cardiovascular disease. Emerging new iron therapies such as heme iron
polypeptide and ferumoxytol may further enhance the tolerability, efficacy,
and ease of administration of iron in PD patients.
KEY WORDS: Darbepoetin; erythropoietin; ferritin; hemoglobin; iron economics; prospective studies.
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