Correcting iron-restricted erythropoiesis and improving anemia in patients on hemodialysis: practical tips that can make a difference.

In healthy individuals, the body remains in an iron-balanced state. Iron intake and loss on a daily basis is minimal, and the majority of iron in the body is recycled. However, patients on hemodialysis may have an insufficient supply of iron available to the bone marrow for erythropoiesis, a condition known as iron-restricted erythropoiesis or inflammation-mediated reticuloendothelial blockade. This state may occur as a result of an inflammatory process and can limit the patient's ability to respond to erythropoiesis-stimulating agents (ESAs). Intravenous (IV) iron supplementation may be needed to overcome iron-restricted erythropoiesis and improve ESA response. This article focuses on the complex relationship among the three I's in anemia management: inflammation, iron-restricted erythropoiesis, and IV iron treatment.