Improvement of Iron Utilization and Anemia in Uremic Patients Switched from Hemodialysis to Continuous Ambulatory Peritoneal Dialysis

Serum ferritin, hematocrit (Ht) and hemoglobin (Hb) were studied in seven patients treated with hemodialysis (HD) who later switched to continuous ambulatory peritoneal dialysis (CAPD). No iron supplements were given during the study. During the whole observation period (12 months on HD and 12 months on CAPD), there was a progressive decrease in serum ferritin during HD, accompanied by a progressive drop in Hb and Ht; on the contrary, on CAPD, Hb and Ht showed a sharp increase despite further ferritin reduction. The CAPD ferritin drop was not due to peritoneal loss of iron or ferritin, which appeared negligible. We propose that the increase in both Ht and Hb in CAPD is due to the removal of toxic factor(s) inhibiting erythropoiesis, which allow(s) increased iron utilization, and consequently a reduction in serum-ferritin levels.

Anemia of chronic renal failure is a complex event to which many factors may contribute -reduced erythrocyte survival, hemolysis, iron losses from gastrointestinal leakage, reduced erythropoiesis, presence of inhibitors of erythropoiesis (1).