Therapeutic targets
Guidelines recommend a target Hb level in CKD patients of 11.0 to 12.0 g/dL; but lower than 13 g/dL and an HCT level of approximately 33 % to 36 %. Intravenous iron administration in EPO treated patients with TSAT levels <20% will lead to an increase in Hb and a decrease in EPO dose. In order to achieve a target Hb with an optimized EPO dose, it is indicated to provide sufficient iron to maintain TSAT levels of ≥20 % and ferritin concentrations of >100 ng/mL in non-HD patients or >200 ng/mL in HD patients.35 In order to avoid overload, no iron should be administered when levels of TSAT are ≥50 % and/or ferritin levels are ≥800 ng/mL.
Both the U.S. guideline (K/DOQI) and the European guideline (EBPG) recommend an anaemia treatment for patients with CKD when Hb levels are below 11.0 g/dL.34, 35 As a general rule, if serum creatinine is ≥2 mg/dL, insufficient EPO production is likely to occur34. Furthermore, serum iron, total iron-binding capacity, transferrin saturation and serum ferritin levels are the routinely used indicators of the availability of iron for erythropoiesis (red blood cell formation) and iron stores.34, 36 A significant decrease in both parameters makes it necessary to provide an additional external supply to guarantee sufficient haematopoesis.
