Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients

• Published in: Nephrology, dialysis, transplantation Vol. 19; no. 1; pp. 141 - 149
• Main Authors: Kalantar-Zadeh, Kamyar, Rodriguez, Rudolph A., Humphreys, Michael H.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-01-2004
• Subjects: Adult; Aged; Aged, 80 and over; Anemia - blood; Anemia - etiology; Anemia - immunology; Anemia - physiopathology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Blood. Blood coagulation. Reticuloendothelial system; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; Female; ferritin; Ferritins - blood; Humans; inflammation; Inflammation - blood; Inflammation - complications; Intensive care medicine; iron; Iron - blood; Iron - metabolism; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Malnutrition - blood; Malnutrition - etiology; Malnutrition - immunology; Malnutrition - physiopathology; malnutrition–inflammation complex syndrome; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Nutritional Status - physiology; Pharmacology. Drug treatments; protein–energy malnutrition; Renal Dialysis; Renal failure; Syndrome; Human; Kidney disease; Urinary system disease; protein-energy malnutrition; Hemodialysis; Nutrition disorder; Ferritin; Terminal stage; Iron; Inflammation; end-stage renal disease; Extrarenal dialysis; malnutrition-inflammation complex syndrome; Renal failure; Malnutrition; Complex syndrome
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfg493

Background. Serum ferritin is a frequently used marker of iron status in dialysis patients. Iron administration is to be withheld for ferritin values >800  ng/ml according to K/DOQI guidelines. We hypothesized that such non-iron-related factors as elements of the malnutrition–inflammation complex syndrome (MICS) may increase serum ferritin concentration independently of iron status. Methods. We studied 82 prevalent maintenance haemodialysis (MHD) patients (including 43 men), aged 55.7 ± 15.3 years. The inflammatory and nutritional status was evaluated by serum C-reactive protein (CRP), Subjective Global Assessment (SGA) and its newer, fully quantitative versions, i.e. Dialysis Malnutrition Score (DMS) and Malnutrition–Inflammation Score (MIS). Results. All but six patients had been on maintenance doses of intravenous iron dextran (between 100 and 200 mg/month) during the 10 weeks prior to the measurements. Serum ferritin levels were increased across SGA categories: (ANOVA P-value 0.03). Both unadjusted and multivariate adjusted correlation coefficients (r) for serum ferritin and CRP vs pertinent values were statistically significant for DMS and MIS and some other measures of nutritional status and iron indices. After deleting 10 MHD patients with either iron deficiency (ferritin <200 ng/ml) or iron overload (ferritin >2000 ng/ml), in the remaining 72 MHD patients both bivariate and multivariate correlations were much stronger and statistically significant (r = −0.33 and −0.29, respectively, P < 0.01). A multivariate model showed simultaneous, significant correlations between serum ferritin and both markers of inflammation and iron status independent of each other. After dividing the 72 MHD patients into two groups of serum ferritin based on a K/DOQI recommended serum ferritin cut-off of 800 ng/ml, the MIS and logarithm of serum CRP were significantly higher in the higher ferritin group. Conclusions. Serum ferritin values in the range of 200–2000 ng/ml may be increased due to non-iron-related factors including elements of MICS.