N. Baiæ-Jukiæ et. al. Hemodialysis and erythrocytosis ERYTHROCYTOSIS IN A HEMODIALYSIS PATIENT TREATED WITH IRON SUCROSE

SUMMARY A 59-year-old Caucasian male started intermittent hemodialysis in March 1995 for the treat-ment of end-stage renal disease of unknown etiology. In December 2002, he started receiving parenteral iron sucrose, 100 mg every two weeks, for iron deficiency. He did not receive erythropoietin. One month later he experienced severe pruritus. Blood analysis revealed erythrocytosis. Iron therapy was discontinued immediately, and four venepunctures were performed to avoid thrombosis of AV fistula. Malignant disease was excluded. It was decided to apply an angiotensin convertase enzyme inhibitor (ACEi), ramipril, in a dose of 2.5 mg/day. However, the patient developed severe cough as a side effect of ramipril and was switched to an angiotensin receptor type II antagonist (AAR), losartan, in a dose of 25 mg/day. While the patient was prone to hypotension during the dialysis sessions, losartan was administered every evening at bedtime. One month after the introduction of AAR, a stable hemoglobin level was achieved. On control MSCT six months later, there was no sign of malignant disease. Oral ACEi and AAR are appropriate treat-ment in the control of erythrocytosis in dialysis patients