From the Guidelines
Patients on dialysis can take ferrous sulfate orally, but it is crucial to do so under medical supervision, as oral iron absorption is often impaired in these patients due to increased hepcidin levels, which block iron absorption in the gut. The decision to use oral iron should be based on the individual patient's needs and response to therapy, considering the potential for impaired absorption and the need for regular monitoring of iron levels, ferritin, and transferrin saturation to prevent both iron deficiency and overload 1.
Key Considerations for Oral Iron Therapy in Dialysis Patients
- The typical dose for dialysis patients is 325 mg (65 mg elemental iron) taken 1-3 times daily between meals, but this may need adjustment based on individual patient response and iron status 1.
- Side effects of oral ferrous sulfate include gastrointestinal discomfort, constipation, nausea, and black stools, which can be mitigated by taking the medication with food, although this may decrease absorption 1.
- Vitamin C can enhance iron absorption if taken simultaneously, which may be beneficial for patients with impaired iron absorption 1.
- Regular monitoring of iron levels, ferritin, and transferrin saturation is essential to guide therapy and prevent complications, with adjustments made as needed to maintain optimal iron status 1.
- Patients should avoid taking ferrous sulfate within 2 hours of phosphate binders, as these medications can interfere with iron absorption, highlighting the need for careful management of concomitant medications 1.
Guidance from Recent Studies
The British Society of Gastroenterology guidelines recommend starting with one tablet per day of ferrous sulphate, fumarate, or gluconate for the initial treatment of iron deficiency anaemia in adults, which can be adapted for dialysis patients under medical supervision 1. However, the specific needs and responses of dialysis patients must be considered, given the potential for impaired oral iron absorption and the necessity for close monitoring of iron status 1.
Conclusion on Oral Iron Use in Dialysis Patients
Given the potential for impaired absorption and the need for close monitoring, oral ferrous sulfate can be used in dialysis patients under medical supervision, with careful consideration of dose, potential side effects, and the need for regular monitoring of iron status. The most recent and highest quality evidence supports the use of oral iron as part of a comprehensive approach to managing iron deficiency in dialysis patients, emphasizing the importance of individualized care and regular assessment of patient response to therapy 1.
From the Research
Oral Iron Supplementation for Dialysis Patients
- Patients on dialysis can take ferrous sulfate orally, but its effectiveness and tolerance may vary compared to other iron supplements 2, 3, 4, 5.
- A study comparing ferrous sulfate and ferrous gluconate in peritoneal dialysis patients found that ferrous gluconate was better absorbed and tolerated than ferrous sulfate 2.
- However, another review of available evidence suggested that oral iron supplements, including ferrous sulfate, may be of little or no benefit in raising hemoglobin and iron indices in patients receiving dialysis 3.
- Other studies have investigated the efficacy of oral iron therapy in patients receiving recombinant human erythropoietin, with varying results depending on the specific iron preparation used 6, 4.
Factors Affecting Response to Oral Iron Therapy
- Serum high-sensitive C-reactive protein (hs-CRP) level may be a parameter for predicting hyporesponsiveness to oral iron therapy 5.
- Compliance and side effects are also important considerations when prescribing oral iron supplements to dialysis patients 2, 3, 4.
- The optimal form and dosage of oral iron supplementation for dialysis patients require further study to determine the most effective and well-tolerated regimen 2, 3, 6, 4, 5.