Iron Deficiency in Hemodialysis Patients – Evaluation of a Combined Treatment with Iron Sucrose and Erythropoietin-Alpha: Predictors of Response, Efficacy and Safety

Chronic kidney disease is a public health problem and one of the outstanding causes of death in the industrialized world. The most serious condition is advanced chronic renal failure requiring replacement therapy by dialysis or kidney transplantation. In recent years the incidence is stabilizing but the prevalence is increasing probably due to the progressive aging of the population and increased comorbidity with other chronic disorders such as diabetes mellitus, hypertension and obesity (de Francisco et al. 2007). It is also a major cause of anemia in developing countries (Maiz, Abderrahim, and Zouaghi 2002) . The long-term survival and good quality of life of patients with chronic renal failure depends, among other factors, on hemoglobin, iron status and bone marrow response to erythropoiesis stimulating agents (ESA). Anemia is an almost constant complication of advanced renal failure which may contribute to worsen preexisting heart disease and, as a consequence, accelerate the progression of renal dysfunction (Kuwahara et al. 2011), (Silverberg et al. 2009). The administration of erythropoietin to patients with kidney and heart failure improves both processes, not only increasing hemoglobin but also by a direct effect of erythropoietin on cardiac function (Belonje, de Boer, and Voors 2008). In general, anemia is normocytic, normochromic and usually well tolerated until the advanced stages of kidney disease. It is usually a complication of stage 3 chronic kidney disease (KDOQI and National Kidney Foundation 2006). Its etiology is multifactorial: shortening of life span of erythrocytes, presence of inhibitors of erythropoiesis in plasma, inadequate production of endogenous erythropoietin (EPO) for the degree of anemia, blood loss, and iron and vitamin deficiency(Tsubakihara et al. 2010) (Belonje, de Boer, and Voors 2008), (Chamney et al. 2010). The outstanding cause is impaired secretion of erythropoietin due to renal disease, while other factors may contribute to its establishment, maintenance or aggravation.