The letter of Dr Gotloib correctly emphasizes a major role that iron deficiency has historically played in the anemic patient with renal failure. However, I think it unlikely that correction of iron deficiency had a major role in the increase in hematocrit values seen in the cases studied at our institution. Serum ferritin values were quite high in most of these patients, and bore no relation to the hematocrit values. Likewise, the amount of blood lost through venipuncture was carefully quantitated both during the periods of hemodialysis therapy and the periods of continuous ambulatory peritoneal dialysis (CAPD) maintenance. There was no relation between blood loss via venipuncture and the relative increase or absolute value of the hematocrit values on CAPD. Likewise, changes in nutrition and the effect of hemoconcentration also did not explain the changes in hematocrit values noted in these very closely studied cases. Only in one of
Steiner RW. Characteristics of Hematocrit Response to Continuous Ambulatory Peritoneal Dialysis-Reply. Arch Intern Med. 1986;146(6):1232. doi:10.1001/archinte.1986.00360180252050
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