Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease
Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe....
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2011-01, Vol.6 (1), p.77-83 |
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| container_title | Clinical journal of the American Society of Nephrology |
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| creator | Ferrari, Paolo Kulkarni, Hemant Dheda, Shyam Betti, Susanne Harrison, Colin St Pierre, Timothy G Olynyk, John K |
| description | Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe.
We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L).
In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis.
In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis. |
| doi_str_mv | 10.2215/CJN.04190510 |
| format | Article |
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We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L).
In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis.
In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.04190510</identifier><identifier>PMID: 20876673</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Adult ; Aged ; Chronic Disease ; Cross-Sectional Studies ; Female ; Ferritins - blood ; Hemoglobins - analysis ; Humans ; Iron - deficiency ; Iron - therapeutic use ; Kidney Diseases - blood ; Liver - metabolism ; Male ; Middle Aged ; Original ; Prospective Studies ; Renal Dialysis ; Transferrin - analysis</subject><ispartof>Clinical journal of the American Society of Nephrology, 2011-01, Vol.6 (1), p.77-83</ispartof><rights>Copyright © 2011 by the American Society of Nephrology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-e9c8abe8d232a0482e0da82cbe570be72ab847050cb25eecef735089964c2e4d3</citedby><cites>FETCH-LOGICAL-c479t-e9c8abe8d232a0482e0da82cbe570be72ab847050cb25eecef735089964c2e4d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022252/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022252/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20876673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferrari, Paolo</creatorcontrib><creatorcontrib>Kulkarni, Hemant</creatorcontrib><creatorcontrib>Dheda, Shyam</creatorcontrib><creatorcontrib>Betti, Susanne</creatorcontrib><creatorcontrib>Harrison, Colin</creatorcontrib><creatorcontrib>St Pierre, Timothy G</creatorcontrib><creatorcontrib>Olynyk, John K</creatorcontrib><title>Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe.
We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L).
In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis.
In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Chronic Disease</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Ferritins - blood</subject><subject>Hemoglobins - analysis</subject><subject>Humans</subject><subject>Iron - deficiency</subject><subject>Iron - therapeutic use</subject><subject>Kidney Diseases - blood</subject><subject>Liver - metabolism</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Prospective Studies</subject><subject>Renal Dialysis</subject><subject>Transferrin - analysis</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkT1PwzAQhi0EglLYmJEXxELBcew4WZBQgVIoIPElNstxrq1L4hQ7AfHvMWqpYLqvR--d7kVoLyLHlEb8pH99d0xYlBEekTXUiTjnvVC8rq9yFm2hbe9nhDAWU76JtihJRZKIuINeHsG1FR662uJb5d7AeXzmAA-tKuC9VQ3gce3woDWFsZMF9wDzEhoTMmNxfxpaRuMbU1j4wufGg_KwgzbGqvSwu4xd9Hx58dS_6o3uB8P-2ainmciaHmQ6VTmkBY2pIiylQAqVUp0DFyQHQVWeMkE40TnlABrGIuYkzbKEaQqsiLvodKE7b_MKCg22caqUc2cq5b5krYz8P7FmKif1h4wJpZTTIHC4FHD1ewu-kZXxGspSWahbL1OWhHUkSwJ5tCC1q713MF5tiYj8cUIGJ-SvEwHf_3vZCv59fQAOFsDUTKafxoH0lSrLgFOpZ8rbREZSiPgb-nGSMA</recordid><startdate>20110101</startdate><enddate>20110101</enddate><creator>Ferrari, Paolo</creator><creator>Kulkarni, Hemant</creator><creator>Dheda, Shyam</creator><creator>Betti, Susanne</creator><creator>Harrison, Colin</creator><creator>St Pierre, Timothy G</creator><creator>Olynyk, John K</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110101</creationdate><title>Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease</title><author>Ferrari, Paolo ; Kulkarni, Hemant ; Dheda, Shyam ; Betti, Susanne ; Harrison, Colin ; St Pierre, Timothy G ; Olynyk, John K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-e9c8abe8d232a0482e0da82cbe570be72ab847050cb25eecef735089964c2e4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Chronic Disease</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Ferritins - blood</topic><topic>Hemoglobins - analysis</topic><topic>Humans</topic><topic>Iron - deficiency</topic><topic>Iron - therapeutic use</topic><topic>Kidney Diseases - blood</topic><topic>Liver - metabolism</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Prospective Studies</topic><topic>Renal Dialysis</topic><topic>Transferrin - analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferrari, Paolo</creatorcontrib><creatorcontrib>Kulkarni, Hemant</creatorcontrib><creatorcontrib>Dheda, Shyam</creatorcontrib><creatorcontrib>Betti, Susanne</creatorcontrib><creatorcontrib>Harrison, Colin</creatorcontrib><creatorcontrib>St Pierre, Timothy G</creatorcontrib><creatorcontrib>Olynyk, John K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferrari, Paolo</au><au>Kulkarni, Hemant</au><au>Dheda, Shyam</au><au>Betti, Susanne</au><au>Harrison, Colin</au><au>St Pierre, Timothy G</au><au>Olynyk, John K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2011-01-01</date><risdate>2011</risdate><volume>6</volume><issue>1</issue><spage>77</spage><epage>83</epage><pages>77-83</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe.
We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L).
In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis.
In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>20876673</pmid><doi>10.2215/CJN.04190510</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Chronic Disease Cross-Sectional Studies Female Ferritins - blood Hemoglobins - analysis Humans Iron - deficiency Iron - therapeutic use Kidney Diseases - blood Liver - metabolism Male Middle Aged Original Prospective Studies Renal Dialysis Transferrin - analysis |
| title | Serum Iron Markers Are Inadequate for Guiding Iron Repletion in Chronic Kidney Disease |
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