What is the optimal level of iron during epoetin alfa (EPO) and darbepoetin alfa (DARB) treatment?
The KDOQI guidelines clarify the levels. I can address the optimal oral dosage of iron. Typically we have given ferrous sulfate 3 times a day in seniors. But the new guidelines, at least the Beers criteria, are saying that ferrous sulfate once a day may be more appropriate. And if we are using a different iron salt, then each of the iron salts has a different concentration of elemental iron. So thats really the key. If you are trying to figure out how much iron the resident should get, ferrous sulfate is about 20% iron; ferrous gluconate is a little more than 11%. So to get the resident to the proper iron and ferritin level, you need to give sufficient ironbut not too much, because the gastrointestinal complications and the constipation may not be worth it. These erythropoietin therapies are so good that we have to monitor for reduced iron substrate as the iron stores are mobilized. We always need to worry about the inflammatory component that blocks iron release. But these treatments
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- What is the optimal level of iron during epoetin alfa (EPO) and darbepoetin alfa (DARB) treatment?
