Abstract
Anemia of patients under maintenance hemodialysis in our center has improved annually for the last eleven years.
Analyses revealed that this improvement was produced by (1) rationalized managements of patients with chronic renal failure and resultant institution of hemodialysis therapy in adequate time (2) improvement in efficiency of dialyzer, dialysis technics and water treatment (3) increase of dialysis-quantity and-frequency (4) more strict criteria for blood transfusion (5) accurate and working knowledge of diet therapy (6) various supplemental therapies for improving anemia etc.
However, it must be kept in mind that about 10% of patients in our center, which has been taking care of about 70 patients, showed Hct less than 20% and moreover hematological conditions of hemodialysis patients were easily influenced even by minor factors to ordinary people.
Iron deficiency is a frequent complication in maintenance hemodialysis patients and therefore supplemental iron therapy has become routine for our patients. Intravenous iron administration resulted in a remarkable improvement of anemia in our patients. But since a measurement of serum ferritin, which provides a simple and reliable method to demonstrate iron repletion or iron overload, became available, it became clear that intravenous iron dextran often resulted in iron overload though we have had no experience of severe organ dysfunction.
We advocated a temporary standard of iron administration.
Our clinical analyses suggest that hemodialysis patients must be always observed carefully in the following ten factors;
(1) quality and quantity of diet (2) G. I. symptoms (3) infection (4) adequate blood access (5) adequate quantity of hemodjalysis (6) blood loss and hemolysis (7) proper supplemental therapies (8) avoidance of heavy blood transfusion and drug-abuse (9) positive attitude to renal transplantation (10) improvement of quality of life.
