Serum ferritin assay and bone-marrow iron stores in patients on maintenance hemodialysis

Bell, John D.; Kincaid, William R.; Morgan, Richard; Bunce, Harvey; Alperin, Jack B.; Sarles, H; Remmers, August R.

doi:10.1038/ki.1980.27

Cited by 69 publications

(34 citation statements)

References 20 publications

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“…Mean serum ferritin levels observed in the three groups of patients, at zero time as well as at the end of the observation period (table 1), were above the suggested normal range of between 30 and 191 µg/l [19, 20, 22, 37, 38]. The differences between the three groups of patients were not significant.…”

Section: Resultsmentioning

confidence: 77%

Correction of Uremic Iron Deficiency Anemia in Hemodialyzed Patients: A Prospective Study

Fudin¹,

Jaichenko²,

Shostak³

et al. 1998

Nephron

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This prospective study was designed to evaluate the eventual correction of anemia and iron status in 39 iron-deficient uremics starting hemodialysis. Nine patients (control group) had no iron supplementation, 10 had oral ferrous iron, and 20 were treated with intravenous iron gluconate. Follow-up periods were 12 months for the control group and 26 months for patients treated with oral or intravenous iron. No patient was treated with erythropoietin. At zero time, all patients were anemic (Hb <78 g/l) and showed signs of severe iron deficiency, diagnosed on the basis of depleted bone marrow iron stores, reduced hemoglobin iron, and transferrin saturation <21%. The hemoglobin levels, observed in patients of the control and the oral iron groups at the end of the follow-up periods, were not significantly different from those detected at zero time. In contradistinction, patients treated with intravenous iron showed after 26 months of follow-up a significant increase of blood hemoglobin values, reaching a mean value of 126 g/l. So far, this evidence supports both the concept that iron absorption is compromised in chronic uremics and that the parenteral way is the more effective route for iron replacement in this specific group of patients.

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Section: Resultsmentioning

confidence: 77%

Correction of Uremic Iron Deficiency Anemia in Hemodialyzed Patients: A Prospective Study

Fudin¹,

Jaichenko²,

Shostak³

et al. 1998

Nephron

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“…SF measurement is known as a noninvasive procedure and its value as an indirect index of the total body iron stores in healthy individuals and chronic renal failure patients receiving hemodialysis or CAPD [12][13][14][15][16][17][18]. The relationship has been investigated by using the cytological grading of bone marrow or liver iron as a parameter of total body iron stores [13,[18][19][20], Based upon these investigations, the SF level can be used as a guideline for iron replacement therapy in MHD or CAPD patients.…”

Section: Discussionmentioning

confidence: 99%

Iron Metabolism Indices for Early Prediction of the Response and Resistance to Erythropoietin Therapy in Maintenance Hemodialysis Patients

Tarng

Chen

Huang³

1995

Am J Nephrol

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A prospective study with 65 maintenance hemodialysis (MHD) patients on recombinant human erythropoietin (rHuEPO) therapy was conducted to assess the effect of iron balance on responsiveness. An attempt to define the predictors of erythropoietin (EPO) response and identify the specific causes of EPO resistance was undertaken in the present study. The treatment protocol consisted of two stages, the first was rHuEPO therapy for 6 months and the second was iron supplementation plus rHuEPO therapy in patients without response to EPO for the next 6 months. According to the hemoglobin (Hb) changes (increment exceeded 30% of baseline or did not exceed 15% of baseline for 3 consecutive months) and whether or not there was an achievement of target Hb level ( > 10.5 g/dl), all patients (n = 65) were divided into EPO-responsive (n = 20) and EPO-resistant (n = 45) groups. The EPO-resistant patients were then further stratified into iron-responsive (n = 29) and iron-irresponsive (n = 16) groups. Iron metabolism and red cell indices were analyzed prior to and following rHuEPO therapy and iron supplementation. We found the following: (1) only serum ferritin (SF) was a reliable discriminator between the EPO-responsive (SF > 300 µg/l) and EPO-resistant (SF < 300µg/l) groups; (2) similarly, transferrin saturation (TFS) 25% was quoted as the best cut-off value between the iron-responsive (TFS < 25%) and iron-irresponsive (TFS > 25%) groups; (3) EPO-resistant patients with TFS < 2 5 % regained proper EPO response (Hb before and 6 months after therapy: 7.8 ± 0.9 vs. 10.6 ± 0.8 g/dl, p < 0.01) and the mean TFS increased significantly (initial TFS and peak level after therapy: 18.9 ± 4.7 vs. 34.5 ± 10.8%, p < 0.01) following iron therapy; (4) the cumulative incidence of TFS < 25% elevated to 44.5% 6 months following initial rHuEPO therapy, and (5) there was a strong inverse relationship between initial TFS and the changes of Hb following iron therapy in EPO-resistant patients (r = -0.75, p < 0.0001). By means of early detection and correction of functional iron deficiency, the goal of increment of therapeutic efficacy and prevention from unnecessarily high doses of rHuEPO can be achieved. In summary, SF > 300 µg/l equates adequate or increased body iron stores and seems to exclude iron deficiency in MHD patients. On the contrary, SF < 300 µg/l appears to be an insufficient diagnostic threshold for iron deficiency. Once resistance occurs during the rHuEPO therapy, in our opinion only patients with TFS < 25% need iron supplementation. However, in patients with TFS > 25% and resistance to EPO, further investigations are necessary before increasing the dose of rHuEPO to explore other possible conditions, such as aluminum overload, severe hyperparathyroidism, occult blood loss or hemolysis, and episodes of infection or inflammatory processes.

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“…[4][5][6][7][8][9][10][11][12] Numerous studies have evaluated the efficacy of serum iron indicators as gauges of iron stores in anemic patients with these chronic diseases. A number of these studies have correlated serum iron measures with bone marrow hemosiderin (Table 1).…”

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confidence: 99%

Detecting iron deficiency in anemic patients with concomitant medical problems

Kis

Carnes

1998

J Gen Intern Med

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OBJECTIVE:To determine the sensitivity and specificity of mean corpuscular volume, transferrin saturation, total ironbinding capacity, and ferritin level in determining iron deficiency in a population of anemic veterans with a wide variety of general medical diagnoses. DESIGN: MEASUREMENTS AND MAIN RESULTS:Using the presence or absence of bone marrow hemosiderin as the reference standard, the sensitivity and specificity of the following serum iron indicators were calculated: mean corpuscular volume, transferrin saturation, total iron-binding capacity, and ferritin level. Of these patients, 41 (40.6%) were categorized as iron deficient, with no stainable bone marrow hemosiderin. A serum ferritin level Յ 100 g/L provided the best sensitivity (64.9%) and specificity (96.1%) for evaluating iron stores in this patient population. When performed within 24 hours of bone marrow examination, a serum ferritin level Յ 100 g/L was 100% accurate in separating iron-deficient from iron-sufficient patients. None of the other serum iron indicators alone or in combination performed better than ferritin level alone. CONCLUSIONS:In a population of anemic veterans with a wide variety of concomitant medical problems, a serum ferritin level Յ 100 g/L was optimal for determining iron deficiency. This is higher than the ferritin level of Յ 50 g/L cited in standard textbooks as evidence of iron deficiency in patients with inflammation, infection, or malignancy.KEY WORDS: iron deficiency; anemia; ferritin; total ironbinding capacity; transferrin saturation. J GEN INTERN MED 1998;13:455-461.

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Serum ferritin assay and bone-marrow iron stores in patients on maintenance hemodialysis

Cited by 69 publications

References 20 publications

Correction of Uremic Iron Deficiency Anemia in Hemodialyzed Patients: A Prospective Study

Correction of Uremic Iron Deficiency Anemia in Hemodialyzed Patients: A Prospective Study

Iron Metabolism Indices for Early Prediction of the Response and Resistance to Erythropoietin Therapy in Maintenance Hemodialysis Patients

Detecting iron deficiency in anemic patients with concomitant medical problems

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