To the Editor.
—The article by Robert W. Steiner, MD, in the April 1984 issue of the Archives1 shows a quite evident tendency for slow and significant increase of hematocrit values during continuous ambulatory peritoneal dialysis (CAPD) in patients previously treated by means of maintenance hemodialysis. Furthermore, when hemodialysis is repeated in those patients, hematocrit values significantly decreased. Physiopathology of both changes still remains unexplained, as well as their unpredictability.One of the main causal factors of the anemia of chronic renal failure is iron deficiency,2,3 which becomes aggravated after starting maintenance hemodialysis4 mainly because of iatrogenic blood losses in the dialyzer, with losses as high as 3 g of elemental iron per year (approximately 500 mL of blood per month).4,5 However, patients with chronic uremia maintained on hemodialysis show significant increase of hematocrit values after correction of iron deficiency by intramuscular iron dextran injection.
Gotloib L, Schustack A. Characteristics of Hematocrit Response to Continuous Ambulatory Peritoneal Dialysis. Arch Intern Med. 1986;146(6):1231–1232. doi:10.1001/archinte.1986.00360180251049