Serum ferritin assay and iron status in chronic renal failure and haemodialysis.

Hussein, Sonay; Prieto, Jesús; O'Shea, Michael; Av, Hoffbrand; Baillod, R A; Moorheàd, J. F.

doi:10.1136/bmj.1.5957.546

Cited by 85 publications

(45 citation statements)

References 7 publications

(1 reference statement)

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“…Their performance is similarly poor in populations of patients with inflammatory rheumatic disease, 26 hematologic malignancies, 18 or chronic renal failure. 12 We suggest that there is abundant evidence from studies in patients with inflammation, infection, maligancy, or chronic renal failure and growing evidence from studies in patients with unselected acute and chronic illnesses that transferrin saturation and TIBC can be eliminated from the evaluation of microcytic or normocytic anemia.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…[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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“…20 Ferritin levels >600 ng/mL in dialysis-dependent CKD patients are associated with evidence of a reciprocal elevation of lipid peroxidation and depression of antioxidant defense. 80 The higher the dose of intravenous iron administered to dialysis patients, the greater the total body iron burden, the higher the serum ferritin level, 83 and the greater the evidence of oxidant stress. 80,84 Persistent oxidative stress in CKD patients promotes inflammation and, in turn, tissue injury, atherogenesis, and increased cardiovascular morbidity and mortality.…”

Section: Dosing Of Intravenous Iron Formulationsmentioning

confidence: 99%

Safety Issues With Intravenous Iron Products in the Management of Anemia in Chronic Kidney Disease

Hayat¹

2008

Clinical Medicine & Research

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“…SF is known as an indirect index of total body iron stores in healthy individuals and uremic patients on dialy sis [29][30][31][32][33]. From quantitative phlebotomy studies, many authors have advocated that iron stores demonstrated an exponential relationship with the SF [12-14, 34, 35].…”

Section: Iron Needs In Hemodialysis Patients On Erythropoietin Therapymentioning

confidence: 99%

Mathematical Approach for Estimating Iron Needs in Hemodialysis Patients on Erythropoietin Therapy

1997

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Functional iron deficiency occurs when recombinant human erythropoietin (rHuEPO) accelerates erythropoiesis to an extent that the iron availability cannot meet the anticipated demand. Such a phenomenon will reduce the optimal response to rHuEPO. To estimate the iron needs of functional iron deficiency in hemodialysis patients on rHuEPO therapy, we utilized a mathematical method. Forty hemodialysis patients were examined in the study, and all had a baseline serum ferritin (SF) level > 100 µg/l. They were stratified into patients with a transferrin saturation (TfS) value ≧ 25% (group I) and those below this value (group II). The treatment protocol consisted of rHuEPO therapy in the two groups for 6 months and iron supplement only in group II. The target hemoglobin level was 10.5 g/dl, and iron metabolism indices were analyzed prior to and following therapy. The results showed (1) in group I (n = 20) hemoglobin rose from 7.5 ± 0.9 to 10.7 ± 0.7 g/dl (p < 0.01) and the mean SF level declined from 1,583 ± 997 to 968 ± 664 mg (p < 0.01); (2) in group II (n = 20) hemoglobin also increased from 7.8 ± 0.9 to 10.6 ± 0.8 g/dl (p < 0.01) following iron supplement, while the SF rose from 183 ± 70 to 326 ± 125 mg (p < 0.01); (3) TfS was significantly elevated in group II following iron therapy (18.9 ± 4.8 vs. 34.5 ± 9.1%, p < 0.01), and (4) the nomogram showed a sensitivity of 80%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 83% in estimating the iron status before rHuEPO therapy. We conclude that SF levels reflect iron stores and that TfS < 25% is an index of functional iron deficiency. Iron supplementation is not necessary in patients with SF > 100 µg/l and TfS ≧25%. It seems rational to provide intravenous iron in EPO-resistant patients with functional iron deficiency (SF > 100 µg/l, TfS < 25%). This paper illustrates the importance that accurate assessment of iron needs by a mathematical method would enhance treatment efficacy and avoid iron overload in hemodialysis patients on rHuEPO therapy.

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Serum ferritin assay and iron status in chronic renal failure and haemodialysis.

Cited by 85 publications

References 7 publications

Detecting iron deficiency in anemic patients with concomitant medical problems

Detecting iron deficiency in anemic patients with concomitant medical problems

Safety Issues With Intravenous Iron Products in the Management of Anemia in Chronic Kidney Disease

Mathematical Approach for Estimating Iron Needs in Hemodialysis Patients on Erythropoietin Therapy

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