Iron: A Guide for Dialysis Patients

Provided by DaVita® Dietitians

Iron is an important mineral that the body uses for a variety of different functions, including making red blood cells that transport oxygen throughout the body.  Low iron levels are referred to as “iron deficiency” and can lead to anemia in people with chronic kidney disease (CKD). Some of the common causes of low iron levels in dialysis patients — particularly for people on hemodialysis and less for those on peritoneal dialysis (PD) — are:

  • Blood loss because of bleeding from the access, surgery, frequent blood tests or remaining blood in blood lines
  • Poor absorption of iron from food in the intestinal tract
  • Not eating enough high iron foods because of poor appetite

Because iron-rich foods are often high in protein, dialysis patients who do not eat enough protein are at risk of iron deficiency. Women can be especially susceptible to low iron levels since iron is lost through menstruation.

Without enough iron you may have:

  • Low energy level and difficulty concentrating
  • Pale skin color or “spoon-shaped nails” (nails that are thin and curved)
  • Anemia (a low hematocrit and a low hemoglobin level)
  • Decreased appetite
  • Shortness of breath

Blood tests will tell you if your iron levels are low, and they include:

  • Iron saturation – Shows the amount of iron available in your blood
  • Ferritin – Reveals the amount of iron stored in your body

How to properly use iron pills

If your iron levels are low, intravenous (IV) iron may be given during your dialysis treatment, or your doctor may prescribe iron pills. Here are tips on how to effectively use iron pills:

  • Take iron pills separately from phosphate binders.
  • Take them between meals or at bedtime.
  • Do not take iron pills with dairy products, coffee, tea or alcohol.
  • Take only the amount prescribed by your doctor.
  • Increase your intake of high iron foods such as lean meat, iron-fortified and iron-enriched cereals and enriched rice.
  • Use an iron skillet for cooking because some of the iron from the skillet is absorbed into food during cooking.

How to get enough iron from foods

Iron is found in foods from both plants and animals, however, the body absorbs iron from animal food sources better than plant food sources. Vitamin C and foods with protein can help increase iron absorption from plant foods. To get vitamin C, choose kidney-friendly foods and drinks such as strawberries, tangerines and vitamin C-enriched cranberry juice. Also, read food labels and look for 20% or more iron per serving.


Iron is an important mineral that is necessary for good health.  Make sure to get adequate amounts by following the guidelines above.  If you notice any symptoms of iron deficiency consult your doctor.  With diet changes and (if necessary) iron pills, you can help restore the proper levels of iron to your body.