Erythropoietin and iron Joachim P. Kaltwasser, René Gottschalk  Kidney International  Volume 55, Pages S49-S56 (March 1999) DOI: 10.1046/j.1523-1755.1999.055Suppl.69049.x Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 1 Changes in serum ferritin concentration in healthy normal subjects as a function of age (according to Dallman et al58; used with permission). Kidney International 1999 55, S49-S56DOI: (10.1046/j.1523-1755.1999.055Suppl.69049.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 2 Correlation of storage iron mobilized by repeated phlebotomy, with serum ferritin concentration in 69 healthy male subjects (○) and 71 patients with genetic hemochromatosis (•) at various clinical stages. Note the direct and linear relationship in storage iron concentrations of less than 2.0g and the remarkable changes of the ferritin to storage iron ratio in storage iron concentration of more than 2.0g. Kidney International 1999 55, S49-S56DOI: (10.1046/j.1523-1755.1999.055Suppl.69049.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 3 Course of hemoglobin and percentage of hypochromic red cells (A) as well as serum ferritin and saturation of TIBC (B) in a female patient with severe inflammatory active rheumatoid arthritis treated with recombinant human erythropoietin (150IU/kg s.c. twice a week) together with an intravenous iron supply (125 to 200mg twice a week). Note the development of functional iron deficiency after initiation of EPO treatment as shown by the inappropriate hemoglobin increase and rise of hypochromic red cells above 10% (left hand side), whereas serum ferritin increased continuously and the saturation of TIBC remained below 20%. Abbreviations are: OP, start of surgical treatment (knee joint TEP); Recormon®, recombinant human erythropoietin; Ferrlecit®, Fe(III) gluconate; Venofer®, iron sucrose complex. Kidney International 1999 55, S49-S56DOI: (10.1046/j.1523-1755.1999.055Suppl.69049.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 4 Course of serum ferritin and soluble transferrin receptor (sTRF-R) during consecutive weekly phlebotomies (500ml) of healthy male subjects (own data; P 0–P 5: phlebotomy week 0 to week 5; number of subjects in brackets). (A) The solid horizontal line indicates serum ferritin values in case of completely exhausted body iron stores. (B) The solid horizontal line indicates the upper normal value of sTRF-R levels. The bars represent the upper and lower two-second interval. There is a continuous increase within the normal range of sTRF-R levels in relation to decreasing iron stores. sTRF-R values cross the upper normal value before the iron stores are completely depleted. Kidney International 1999 55, S49-S56DOI: (10.1046/j.1523-1755.1999.055Suppl.69049.x) Copyright © 1999 International Society of Nephrology Terms and Conditions