Markers of masked iron deficiency and effectiveness of EPO therapy in chronic renal failure

Ahluwalia, Naman; Skikne, Barry S.; Savin, Virginia J.; Chonko, Arnold M.

doi:10.1016/s0272-6386(97)90313-9

Cited by 53 publications

(24 citation statements)

References 28 publications

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“…Also the significant relation between s-TfR and reticulocytes in the present study shows the influence of erythropoiesis on s-TfR levels. Summarizing, although on one hand the absence of a relationship between inflammation and s-TfR is an important advantage for the use of this marker as a parameter of iron state in dialysis patients, a serious drawback of s-TfR in patients treated with rh-EPO is its strong relation with erythropoiesis [10]. …”

Section: Discussionmentioning

confidence: 99%

A Comparison between the Soluble Transferrin Receptor, Transferrin Saturation and Serum Ferritin as Markers of Iron State in Hemodialysis Patients

Beerenhout

Bekers²,

Kooman³

et al. 2002

Nephron

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An adequate iron management is important in the treatment of anemia and in hemodialysis (HD) patients. Serum ferritin and transferrin saturation (TS) may be influenced by the presence of inflammation. Recently, the soluble transferrin receptor (s-TfR) has been advocated as a parameter of iron status in HD patients. The aim of the present study was to assess firstly the relation between serum ferritin, TS, and s-TfR in HD patients and to predict their agreement (assessed by kappa) in the diagnosis of iron deficiency, and, secondly, to assess the influence of inflammation on the relation between the parameters of iron state. Iron deficiency by either marker was respectively defined as ferritin <100 µg/l, TS <20%, or s-TfR >2.4 µg/ml. In the overall group of patients, TS and s-TfR were significantly related (r = –0.38), whereas s-TfR and serum ferritin were not. Both serum ferritin and TS were related to CRP (r = 0.50 and –0.34; p < 0.05), whereas s-TfR was not. The kappa value for agreement between serum ferritin and TS in the diagnosis of iron deficiency was 0.24 (p = 0.07), 0.12 (p = NS) for the agreement between TS and s-TfR and 0 for that between serum ferritin and s-TfR. In patients with CRP levels ≤2 mg/l (n = 16), the relation between parameters of iron state did not improve. Concluding, a large disagreement is observed between ferritin, TS and sTfR as markers of iron deficiency in HD patients, which appears to be only partly explained by the effect of inflammation.

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Section: Discussionmentioning

confidence: 99%

A Comparison between the Soluble Transferrin Receptor, Transferrin Saturation and Serum Ferritin as Markers of Iron State in Hemodialysis Patients

Beerenhout

Bekers²,

Kooman³

et al. 2002

Nephron

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“…If sTfR was mostly a marker of functional iron deficiency induced by rHuEpo, it should increase more consistently in nonresponders (primary cause of failure is functional iron deficiency) than in responders: in fact the reverse is true [33,118]. In addition, sTfR increments correlate well with later hematocrit increases [32], whereas levels are not different in patients with low or high ferritin [119] and correction of iron deficiency with oral iron is associated with little changes [118,120]. Furthermore, the elevation of sTfR in response to rHuEpo is larger in iron overloaded rats than in normal animals who develop functional iron deficiency [121].…”

Section: Soluble Tfr: a Marker Of Iron Status And/or Erythropoiesis?mentioning

confidence: 99%

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

Béguin

2003

Clinica Chimica Acta

398

316

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Iron transport in the plasma is carried out by transferrin, which donates iron to cells through its interaction with a specific membrane receptor, the transferrin receptor (TfR). A soluble form of the TfR (sTfR) has been identified in animal and human serum. Soluble TfR is a truncated monomer of tissue receptor, lacking its first 100 amino acids, which circulates in the form of a complex of transferrin and its receptor. The erythroblasts rather than reticulocytes are the main source of serum sTfR. Serum sTfR levels average 5.0 F 1.0 mg/l in normal subjects but the various commercial assays give disparate values because of the lack of an international standard. The most important determinant of sTfR levels appears to be marrow erythropoietic activity which can cause variations up to 8 times below and up to 20 times above average normal values. Soluble TfR levels are decreased in situations characterized by diminished erythropoietic activity, and are increased when erythropoiesis is stimulated by hemolysis or ineffective erythropoiesis. Measurements of sTfR are very helpful to investigate the pathophysiology of anemia, quantitatively evaluating the absolute rate of erythropoiesis and the adequacy of marrow proliferative capacity for any given degree of anemia, and to monitor the erythropoietic response to various forms of therapy, in particular allowing to predict response early when changes in hemoglobin are not yet apparent. Iron status also influences sTfR levels, which are considerably elevated in iron deficiency anemia but remain normal in the anemia of inflammation, and thus may be of considerable help in the differential diagnosis of microcytic anemia. This is particularly useful to identify concomitant iron deficiency in a patient with inflammation because ferritin values are then generally normal. Elevated sTfR levels are also the characteristic feature of functional iron deficiency, a situation defined by tissue iron deficiency despite adequate iron stores. The sTfR/ferritin ratio can thus describe iron availability over a wide range of iron stores. With the exception of chronic lymphocytic leukemia (CLL) and high-grade non-Hodgkin's lymphoma and possibly hepatocellular carcinoma, sTfR levels are not increased in patients with malignancies. We conclude that soluble TfR represents a valuable quantitative assay of marrow erythropoietic activity as well as a marker of tissue iron deficiency. D

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“…Furthermore, we have been allowed to assume that also old markers such as transferrin saturation and ferritin may still be a ‘first-line’ step for optimizing iron balance during EPO therapy. However, the new parameters that have been recently proposed as more reliable for evaluating iron balance such as % hypochromic red cell and zinc protoporphyrin [4, 5, 6]may provide more suitable insight eventually leading to more precise diagnostic and therapeutic strategies.…”

Section: Introductionmentioning

confidence: 99%

How to Save Money for Erythropoietin Therapy by Changing from ‘Roller Coaster’ to Continuous Iron Supplementation

Canavese

Grill

Costanzi

et al. 1999

Nephron

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Markers of masked iron deficiency and effectiveness of EPO therapy in chronic renal failure

Cited by 53 publications

References 28 publications

A Comparison between the Soluble Transferrin Receptor, Transferrin Saturation and Serum Ferritin as Markers of Iron State in Hemodialysis Patients

A Comparison between the Soluble Transferrin Receptor, Transferrin Saturation and Serum Ferritin as Markers of Iron State in Hemodialysis Patients

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

How to Save Money for Erythropoietin Therapy by Changing from ‘Roller Coaster’ to Continuous Iron Supplementation

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