Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?

Abstract

In non-dialysis chronic kidney disease patients, looking for iron deficiency is highly variable in practice and there is a great variability regarding the cutoffs used to treat iron deficiency. The aim of this study is to investigate the degree of iron deficiency in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents. We included all non-dialysis chronic kidney disease patients that applied to the Lebanese Ministry of Public Health for erythropoiesis-stimulating agents’ coverage during a 5-month period. Iron requirement was assessed based on two guidelines’ target-to-treat cutoffs: 1-ferritin <100 ng/ml and/or TSAT < 20% (KDOQI 2006), 2- ferritin ≤500 ng/ml and TSAT ≤30% (KDIGO 2012). A total of 238 CKD patients were included over 5 months. All patients had a ferritin level in their record and 64% had an available TSAT. Median age was 71.0 (59.8–79.3) years and 61.8% were female. All had an eGFR<60 ml/min. The proportion of patients found to require iron therapy ranged between 48 and 78% with a trend towards higher values when using KDIGO-based criteria. Using ANCOVA test, inverse normal transformations of ferritin and TSAT showed a reverse pattern between men and women with women being more iron deficient in the early stage. Iron deficiency is highly prevalent in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents’ therapy. These findings reflect a lack in effective iron supplementation when managing anemia in pre-dialysis patients, especially in men at advanced stages. Renal societies should spread awareness about iron deficiency screening in those patients.

Clinical characteristics of anemia in chronic kidney disease of patients of the National Hospital in 2018

“…La anemia ferropénica se debe a la dieta pobre en este mineral o a la absorción intestinal inadecuada por efecto de la hepcidina. También puede deberse a pérdidas gastrointestinales o por la circulación extracorpórea durante la (8,18). hemodiálisis Características clínicas de la anemia en la enfermedad renal crónica de pacientes del Hospital Nacional en 2018 Otras causas son: deficiencia de folatos y vitamina B12, disminución de la disponibilidad de hierro para la eritropoyesis y el aumento de los niveles de hepcidina, hemólisis durante la hemodiálisis, intoxicación por aluminio, efecto de las citoquinas inflamatorios debida a infección e inflamación (5,11) crónica, la hemodilución .…”

“…La anemia por déficit de hierro en la ERC se define por la concentración sérica de ferritina <100 (8,13) ng/mL e índice de saturación de transferrina <20%…”

“…Así, la incidencia de la anemia es <10% en los estadios 1 y 2 de la ERC, de 20 a 40% en el estadio 3, de 50 a (3,5,6) 60% en el estadio 4 y >70% en el estadio 5 . La correlación entre clearance de creatinina y anemia (7)(8)(9) observada en un estudio fue +,04 . En pacientes diabéticos con ERC la anemia se correlaciona (10) negativamente con los niveles de HbA1c .…”

“…Un estudio similar en España halló una prevalencia de 58% de anemia en ERC, siendo la ferropenia la causa en 53% de todos los (7) casos . En Brasil se encontró que la ferropenia está presente en 78% de los pacientes adultos con (8) ERC, a pesar de recibir tratamiento con eritropoyetina. La prevalencia fue mayor en las mujeres .…”

The correlation between creatinine serum with total iron binding capacity (TIBC) on patients with sufferers chronic renal disease in Gambiran regional public hospital Kediri city

“…Erythropoietin (EPO) deficiency remains the major cause of anemia in CKD patients due to the decrease in renal EPO production. 14 The presence of anemia in patients with mild to moderate reduction in eGFR can be interpreted as of renal origin, however other factors may be contributing, In this cases It is important to identify iron deficiency anemia, which is the most frequent cause of anemiaespecially in patients receiving antiplatelet or anticoagulant treatmentsor of other types of anemia such as deficiency of vitamin B12 or folic acid. Sometimes both types of anemia, renal and iron deficiency may coexist.…”