Influence of inflammation on the relation between markers of iron deficiency in renal replacement therapy

Iron deficiency is an important factor in the management of anemia in both dialysis and transplant patients. Serum ferritin and transferrin saturation (TS) may be influenced by the presence of inflammation. Recently, the soluble transferrin receptor (s-TfR) has been considered to be a marker of func...

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Published in:	Transplantation proceedings Vol. 36; no. 1; pp. 41 - 43
Main Authors:	Yavuz, A, Akbaş, S.H, Tuncer, M, Kolağası, O, Çetinkaya, R, Gürkan, A, Demirbaş, A, Gultekin, M, Akaydın, M, Ersoy, F, Yakupoğlu, G
Format:	Journal Article Conference Proceeding
Language:	English
Published:	New York, NY Elsevier Inc 01-01-2004 Elsevier Science
Subjects:	Adult Anemia - etiology Biological and medical sciences Biomarkers - blood Female Ferritins - blood Humans Inflammation - physiopathology Iron - deficiency Iron - metabolism Kidney Transplantation Male Medical sciences Metabolic diseases Metals (hemochromatosis...) Other metabolic disorders Peritoneal Dialysis, Continuous Ambulatory Postoperative Complications - blood Renal Replacement Therapy - adverse effects Serum Amyloid A Protein - analysis Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Replacement therapy Iron deficiency anemia Biological marker Metabolic diseases Hemopathy Iron Inflammation Transplantation Enzymopathy Inorganic element Kidney Urinary system Surgery Graft Sideropenia
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Summary:	Iron deficiency is an important factor in the management of anemia in both dialysis and transplant patients. Serum ferritin and transferrin saturation (TS) may be influenced by the presence of inflammation. Recently, the soluble transferrin receptor (s-TfR) has been considered to be a marker of functional iron stores. In this study, parameters of the iron state were investigated in terms of agreement (assessed by kappa) with the diagnosis of iron deficiency and with inflammation. The study was performed in 38 hemodialysis, 31 continuous ambulatory peritoneal dialysis, and 21 anemic renal transplant patients. CRP and amyloid A protein (AAP) were studied as markers of inflammation. Iron deficiency was defined as ferritin <100 mg/L, TS <20%, or s-TfR >1.76 mg/mL. We observed that s-TfR levels were significantly related to both dialysis duration (r = 0.28 in dialysis and r = 0.60 in transplant patients, both P < .05) and PTH levels (r = 0.23 in dialysis and r = 0.55 in transplant patients, both P < .05). Among the transplant group, ferritin and TS, as well as TS and s-TfR were significantly related (r = 0.84 and r = −0.64, respectively), but not s-TfR and ferritin. Among the dialysis group, ferritin and TS, and also TS and s-TfR, were significantly related (r = 0.35 and r = −0.30, respectively), whereas s-TfR and ferritin were not. In the transplant group, the kappa value for agreement between ferritin and TS in the diagnosis of iron deficiency was 0.76 (P = .006), and 0.33 (P = .04), respectively. Among patients with CRP levels <0.3 mg/L or AAP levels <6.4 mg/L, the relation between parameters of iron state was more robust. The kappa value for agreement between ferritin and s-TfR was 0.49 (P = .006) in the dialysis group and 1 (P = .002) for that between ferritin and TS in the transplant group. Our results suggest that PTH levels may influence s-TfR levels. Discordance between ferritin, TS, and s-TfR as markers of iron deficiency might be explained by the effects of inflammation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0041-1345 1873-2623
DOI:	10.1016/j.transproceed.2003.11.054