Iron management in renal anaemia

2015 ◽  
Author(s):  
Iain C. Macdougall
Keyword(s):  
Bone Marrow ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Intravenous Route ◽  
Iron Release ◽  
Renal Anaemia ◽  
Body Iron ◽  
Iron Stores ◽  
Iv Iron ◽  
Total Body

Although erythropoiesis-stimulating agent therapy is the mainstay of renal anaemia management, maintenance of an adequate iron supply to the bone marrow is also pivotal in the process of erythropoiesis. Thus, it is important to be able to detect iron insufficiency, and to treat this appropriately. Iron deficiency may be absolute (when the total body iron stores are exhausted) or functional (when the total body iron stores are normal or increased, but there is an inability to release iron from the stores rapidly enough to provide a ready supply of iron to the bone marrow). Several markers of iron status have been tested, but those of the greatest utility are the serum ferritin, transferrin saturation, and percentage of hypochromic red cells. Measurement of serum hepcidin, which is the master regulator of iron homoeostasis, has to date proved disappointing as a means of detecting iron insufficiency, and none of the available iron markers reliably exclude the need for supplemental iron. Iron may be replaced by either the oral or the intravenous route. In the advanced stages of chronic kidney disease, however, hepcidin is upregulated, and this powerfully inhibits the absorption of iron from the gut. Thus, such patients often require intravenous iron, particularly those on dialysis. Several intravenous (IV) iron preparations are available, and they have in common a core containing an iron salt, surrounded by a carbohydrate shell. The IV iron preparations differ in their kinetics of iron release from the iron–carbohydrate complex. In recent times, several new IV iron preparations have become available, and these allow a greater amount of iron to be given more rapidly as a single administration, without the need for a test dose.

The influence of high-altitude living on body iron

Blood ◽  
2005 ◽  
Vol 106 (4) ◽  
pp. 1441-1446 ◽  
Author(s):  
James D. Cook ◽  
Erick Boy ◽  
Carol Flowers ◽  
Maria del Carmen Daroca
Keyword(s):  
Standard Error ◽  
Transferrin Receptor ◽  
Quantitative Assessment ◽  
Iron Status ◽  
Dietary Iron ◽  
Body Iron ◽  
Iron Stores ◽  
Iron Deficient ◽  
Iron Based ◽  
Maternal Iron

Abstract The quantitative assessment of body iron based on measurements of the serum ferritin and transferrin receptor was used to examine iron status in 800 Bolivian mothers and one of their children younger than 5 years. The survey included populations living at altitudes between 156 to 3750 m. Body iron stores in the mothers averaged 3.88 ± 4.31 mg/kg (mean ± 1 SD) and 1.72 ± 4.53 mg/kg in children. No consistent effect of altitude on body iron was detected in children but body iron stores of 2.77 ± 0.70 mg/kg (mean ± 2 standard error [SE]) in women living above 3000 m was reduced by one-third compared with women living at lower altitudes (P < .001). One half of the children younger than 2 years were iron deficient, but iron stores then increased linearly to approach values in their mothers by 4 years of age. When body iron in mothers was compared with that of their children, a striking correlation was observed over the entire spectrum of maternal iron status (r = 0.61, P < .001). This finding could provide the strongest evidence to date of the importance of dietary iron as a determinant of iron status in vulnerable segments of a population. (Blood. 2005;106:1441-1446)

scholarly journals CORRECTION OF IRON DEFICIENCY IN CKD V HD PATIENTS WITH ANEMIA

2016 ◽  
pp. 66-70
Author(s):  
N. Kolesnyk
Keyword(s):  
Iron Status ◽  
Transferrin Saturation ◽  
Sufficient Evidence ◽  
Iron Losses ◽  
Routine Administration ◽  
Kdigo Guidelines ◽  
Iv Iron ◽  
Laboratory Investigations ◽  
Iron Deficit ◽  
Additional Iron

Hemodialysys results in loss of15-20 ml of blood or 5-7 mg of iron during each session or at least 1 g/ year. Additional iron may be lost through the gastrointestinal tract and during the menstruation in women. Excluding others possible reasons (genitourinary issues, laboratory investigations iron losses can amount minimum 1.7g per year). Dietary iron intake (0.5 – 1.0 g/year) only partially offsets iron deficit. According to KDOQI Anemia Guidelines (2006), “the average iv iron needed to maintain a stable serum ferritin (SF) level and in that way neutral iron balance, appears to be range 22-65 mg/week; this amount corresponds with SFl > 200 mg/ at but the same time there is no sufficient evidence to recommend routine administration of iron if SF > 500 mg/l. KDIGO Guidelines (2012) do not recommend routine use of iron supplementation in patients with transferrin saturation (TSAT) > 30% and SF > 500 mg/1. Thereby the target SF and TSAT levels in CKD VD patients remain controversial and in practice are determined by specific clinical tasks requiring resolution: to increase hemoglobin level without erythropoiesis stimulating agents (ESA) administration, or to decrease ESA dose in its turn depends on specific patient’s iron status (absolute or functional iron deficit) and treatment period, – predialysis or dialysis.

scholarly journals Iron Status of Burkinabé Adolescent Girls Predicts Malaria Risk in the Following Rainy Season

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1446 ◽  
Author(s):  
Loretta Brabin ◽  
Stephen A. Roberts ◽  
Halidou Tinto ◽  
Sabine Gies ◽  
Salou Diallo ◽  
...  
Keyword(s):  
Adolescent Girls ◽  
Rainy Season ◽  
Iron Supplementation ◽  
Iron Status ◽  
Malaria Risk ◽  
Infection Prevalence ◽  
Asymptomatic Malaria ◽  
Body Iron ◽  
Iron Stores ◽  
Safety Outcome

High levels of storage iron may increase malaria susceptibility. This risk has not been investigated in semi-immune adolescents. We investigated whether baseline iron status of non-pregnant adolescent girls living in a high malaria transmission area in Burkina Faso affected malaria risk during the following rainy season. For this prospective study, we analysed data from an interim safety survey, conducted six months into a randomised iron supplementation trial. We used logistic regression to model the risk of P. falciparum infection prevalence by microscopy, the pre-specified interim safety outcome, in relation to iron status, nutritional indicators and menarche assessed at recruitment. The interim survey was attended by 1223 (82%) of 1486 eligible participants, 1084 (89%) of whom were <20 years at baseline and 242 (22%) were pre-menarcheal. At baseline, prevalence of low body iron stores was 10%. At follow-up, 38% of adolescents had predominantly asymptomatic malaria parasitaemias, with no difference by menarcheal status. Higher body iron stores at baseline predicted an increased malaria risk in the following rainy season (OR 1.18 (95% CI 1.05, 1.34, p = 0.007) after adjusting for bed net use, age, menarche, and body mass index. We conclude that routine iron supplementation should not be recommended without prior effective malaria control.

scholarly journals P0861THE RELATIONSHIP BETWEEN HEPCIDIN-25 AND BONE MARROW IRON IN ANEMIC, NON-DIALYSIS, CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Cristina-Stela Capusa ◽  
Ana-Maria Mehedinti ◽  
Gabriela-Adriana Talimba ◽  
Ana Stanciu ◽  
Liliana Viasu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Bone Marrow ◽  
Kidney Disease ◽  
Linear Regression ◽  
Iron Content ◽  
Blood Smear ◽  
Transferrin Saturation ◽  
Peripheral Blood Smear ◽  
Iron Stores ◽  
Bone Marrow Iron

Abstract Background and Aims Hepcidin-25 (Hep25) is a key known regulator of iron metabolism and its interactions with inflammation, iron stores and erythropoietic activity were involved in the pathogenesis of chronic kidney disease (CKD)-associated anemia. Therefore, our aim was to assess the determinants of serum Hep25 level in non-dialysis CKD patients. Method In this cross-sectional, single-center study, 52 subjects (56% men, 65±13 years) with CKD [estimated glomerular filtration rate, eGFR 14.5 (95%CI 16 to 25) mL/min] and anemia [hemoglobin, Hb 9.8 (95%CI 9.2 to 9.9) g/dL], not treated with erythropoiesis-stimulating agents (ESA) or iron in the previous 6 months, were enrolled. Patients with anemia of other causes than CKD, active infectious and inflammatory diseases, malignancy, severe hyperparathyroidism, transfusions during the last 3 months, and immunosuppressive therapy were excluded. The iron status was evaluated using both peripheral and central parameters. The iron stores were assessed by serum ferritin (Fer) and iron content in bone marrow macrophages (iMf, measured quantitively on a scale from 0 to 6). The iron available for erythropoiesis was assessed by transferrin saturation (TSAT) and the percentage of sideroblasts (%Sb). Anemia was further evaluated by a peripheral blood smear, erythrocytes indices and reticulocyte index. Serum Hep25 and erythropoietin (Epo) were assessed by ELISA (Bachem®, and Abcam® 119522, respectively). C-reactive protein (CRP), albumin, and parameters of kidney disease (eGFR, proteinuria) were also measured. Mann-Whitney, Kruskal-Wallis, Chi2 tests, Spearman bivariate correlation and multiple linear regression were used for statistical analysis. Results The median serum Hep25 of the whole cohort was 82.1 (95%CI 68.7 to 92.1) ng/mL. According to median Hep25, subjects were clustered in Group 1 (below median - G1) and Group 2 (above median - G2). %Sb and reticulocyte index had higher levels in G2 than in G1 [9 (95%CI 5 to 14) vs. 5 (95%CI 4 to 7) %, p=0.003 and 0.55 (95%CI 0.39 to 0.77) vs. 0.41 (95%CI 0.32 to 0.58), p=0.05, respectively], while the proportions of subjects with iMf suggestive for iron deficiency or iron overload were similar in G2 and G1 (38% vs. 50%, p=0.40, and 26% vs. 23%, p= 0.75, respectively). Peripheral blood smear, peripheral iron indices and all the other studied parameters were also alike. In bivariate analysis, Hep25 was positively associated both with indices of iron stores, i.e. Fer (rs = 0.30, p=0.03) and iMf (rs = 0.34, p=0.01) and indices of iron available for erythropoiesis, i.e. %Sb (rs = 0.55, p&lt;0.001) and (marginally) with TSAT (rs = 0.26, p=0.06). Meanwhile, Hep25 was not related to serum Epo, CKD parameters or inflammation markers. In a multivariate linear regression model that explained 28% of Hep25 variation, the percentage of bone marrow sideroblasts, i.e. the tissue iron available for erythropoiesis, was the only independent determinant of Hep25: Variables entered in the first step: reticulocyte index, percentage of medullary sideroblasts (%Sb), iron content in the bone marrow macrophages (iMf), serum ferritin, and transferrin saturation Conclusion In stable patients with advanced CKD, not treated with ESA or iron, with low to moderate inflammation, serum hepcidin was related only to bone marrow iron available for erythropoiesis, suggesting that in this clinical setting the need of iron for erythropoiesis prevails over inflammation in regulation of hepcidin synthesis.

Relationship Between Iron Indices and Iron Responsiveness Following IV Ferumoxytol or Oral Iron In Patients with CKD Not on Dialysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5149-5149
Author(s):  
John Adamson ◽  
Zhu Li ◽  
Paul Miller ◽  
Annamaria Kausz
Keyword(s):  
Iron Deficiency ◽  
Serum Ferritin ◽  
Iron Status ◽  
Oral Iron ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Functional Iron Deficiency ◽  
Iron Stores ◽  
Iv Iron ◽  
Definition Of

Abstract Abstract 5149 BACKGROUND Iron deficiency anemia (IDA) is associated with reduced physical functioning, cardiovascular disease, and poor quality of life. The measurement of body iron stores is essential to the management of IDA, and the indices most commonly used to assess iron status are transferrin saturation (TSAT) and serum ferritin. Unfortunately, serum ferritin is not a reliable indicator of iron status, particularly in patients with chronic kidney disease (CKD), because it is an acute phase reactant and may be elevated in patients with iron deficiency in the presence of inflammation. Recent clinical trials have shown that patients with iron indices above a strict definition of iron deficiency (TSAT >15%, serum ferritin >100 ng/mL), do have a significant increase in hemoglobin (Hgb) when treated with iron. These results are consistent with recent changes to the National Cancer Comprehensive Network (NCCN) guidelines, which have expanded the definition of functional iron deficiency (relative iron deficiency) to include a serum ferritin <800 ng/mL; previously, the serum ferritin threshold was <300 ng/mL. Additionally, for patients who meet this expanded definition of functional iron deficiency (TSAT <20%, ferritin <800 ng/mL), it is now recommended that iron replacement therapy be considered in addition to erythropoiesis-stimulating agent (ESA) therapy. Ferumoxytol (Feraheme®) Injection, a novel IV iron therapeutic agent, is indicated for the treatment of IDA in adult patients with CKD. Ferumoxytol is composed of an iron oxide with a unique carbohydrate coating (polyglucose sorbitol carboxymethylether), is isotonic, has a neutral pH, and evidence of lower free iron than other IV irons. Ferumoxytol is administered as two IV injections of 510 mg (17 mL) 3 to 8 days apart for a total cumulative dose of 1.02 g; each IV injection can be administered at a rate up to 1 mL/sec, allowing for administration of a 510 mg dose in less than 1 minute. METHODS Data were combined from 2 identically designed and executed Phase III randomized, active-controlled, open-label studies conducted in 606 patients with CKD stages 1–5 not on dialysis. Patients were randomly assigned in a 3:1 ratio to receive a course of either 1.02 g IV ferumoxytol (n=453) administered as 2 doses of 510 mg each within 5±3 days or 200 mg of oral elemental iron (n=153) daily for 21 days. The main IDA inclusion criteria included a Hgb ≤11.0 g/dL, TSAT ≤30%, and serum ferritin ≤600 ng/mL. The mean baseline Hgb was approximately 10 g/dL, and ESAs were use by approximately 40% of patients. To further evaluate the relationship between baseline markers of iron stores and response to iron therapy, data from these trials were summarized by baseline TSAT and serum ferritin levels. RESULTS Overall, results from these two pooled trials show that ferumoxytol resulted in a statistically significant greater mean increase in Hgb relative to oral iron. When evaluated across the baseline iron indices examined, statistically significant (p<0.05) increases in Hgb at Day 35 were observed following ferumoxytol administration, even for subjects with baseline iron indices above levels traditionally used to define iron deficiency. Additionally, at each level of baseline iron indices, ferumoxytol produced a larger change in Hgb relative to oral iron. These data suggest that patients with CKD not on dialysis with a wide range of iron indices at baseline respond to IV iron therapy with an increase in Hgb. Additionally, ferumoxytol consistently resulted in larger increases in Hgb relative to oral iron across all levels of baseline iron indices examined. Disclosures: Adamson: VA Medical Center MC 111E: Honoraria, Membership on an entity's Board of Directors or advisory committees. Li:AMAG Pharmaceuticals, Inc.: Employment. Miller:AMAG Pharmaceuticals, Inc.: Employment. Kausz:AMAG Pharmaceuticals, Inc.: Employment.

Effect Of Maternal Cigarette Smoking On Newborn Iron Stores

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4671-4671 ◽  
Author(s):  
Irina Pateva ◽  
Elisabeth Kerling ◽  
Susan Carlson ◽  
Manju Reddy ◽  
Dan Chen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Conflicts Of Interest ◽  
Smoking Status ◽  
Newborn Infants ◽  
Significant Negative Correlation ◽  
Matched Pair ◽  
Small Scale ◽  
Body Iron ◽  
Iron Stores ◽  
Total Body

Objective Previous small-scale studies suggest that maternal smoking lowers neonatal body iron. Our objective was to study and compare the relationship between maternal and infants’ body iron in smokers and non-smokers in a large matched-pair cohort. Method This was a prospective cohort study involving 144 mothers – 72 smokers and 72 non-smokers and their respective infants. Samples were obtained from maternal blood and infants’ cord blood at delivery for serum transferrin receptor (sTfR) and ferritin levels. Serum TfR and ferritin levels were measured by RAMCO ELISA and RIA assays. The total body iron (TBI) was calculated using the sTfR/ferritin ratio. Results Maternal total body iron and smoking status Women who smoked had lower sTfR, higher ferritin and higher body iron compared to nonsmoking women. Infant’s total body iron, measurements at birth and smoking status In contrast to their respective mothers, we found a small but statistically significant negative correlation between smoking and infants’ total body iron. The number of PPD smoked was negatively correlated with infants’ ferritin and total body iron. The number of days smoked during pregnancy was also negatively correlated with infants’ ferritin and total body iron and positively correlated with infants' sTfR. Birth weight was lower in babies of smokers compared to nonsmokers (mean /- SD =3270 +/-475 vs. 3393 g +/- 475 g, p=0.03). Correlation studies revealed that birth weight in infants of smokers was negatively correlated with PPD smoked and number of days smoked. Birth length in the same infants was also negatively correlated with PPD smoked and number of days smoked. Conclusion Mothers who smoked during pregnancy had higher iron stores but their newborn infants had lower iron stores than those of non-smoking mothers. There may be a negative dose-dependent response between fetal smoke exposure and infant iron stores. Disclosures: No relevant conflicts of interest to declare.

Increased plasma transferrin, altered body iron distribution, and microcytic hypochromic anemia in ferrochelatase-deficient mice

Blood ◽  
2006 ◽  
Vol 109 (2) ◽  
pp. 811-818 ◽  
Author(s):  
Saïd Lyoumi ◽  
Marie Abitbol ◽  
Valérie Andrieu ◽  
Dominique Henin ◽  
Elodie Robert ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Iron Deficiency ◽  
Iron Status ◽  
Hypochromic Anemia ◽  
Receptor Expression ◽  
Mutant Mice ◽  
Deficiency Anemia ◽  
Peripheral Tissues ◽  
Iron Distribution ◽  
Iron Stores

Abstract Patients with deficiency in ferrochelatase (FECH), the last enzyme of the heme biosynthetic pathway, experience a painful type of skin photosensitivity called erythropoietic protoporphyria (EPP), which is caused by the excessive production of protoporphyrin IX (PPIX) by erythrocytes. Controversial results have been reported regarding hematologic status and iron status of patients with EPP. We thoroughly explored these parameters in Fechm1Pas mutant mice of 3 different genetic backgrounds. FECH deficiency induced microcytic hypochromic anemia without ringed sideroblasts, little or no hemolysis, and no erythroid hyperplasia. Serum iron, ferritin, hepcidin mRNA, and Dcytb levels were normal. The homozygous Fechm1Pas mutant involved no tissue iron deficiency but showed a clear-cut redistribution of iron stores from peripheral tissues to the spleen, with a concomitant 2- to 3-fold increase in transferrin expression at the mRNA and the protein levels. Erythrocyte PPIX levels strongly correlated with serum transferrin levels. At all stages of differentiation in our study, transferrin receptor expression in bone marrow erythroid cells in Fechm1Pas was normal in mutant mice but not in patients with iron-deficiency anemia. Based on these observations, we suggest that oral iron therapy is not the therapy of choice for patients with EPP and that the PPIX–liver transferrin pathway plays a role in the orchestration of iron distribution between peripheral iron stores, the spleen, and the bone marrow.

Iron Status of Highly Active Adolescents: Evidence of Depleted Iron Stores in Gymnasts

2000 ◽  
Vol 10 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Naama W. Constantini ◽  
Alon Eliakim ◽  
Levana Zigel ◽  
Michal Yaaron ◽  
Bareket Falk
Keyword(s):  
Iron Deficiency ◽  
Female Athletes ◽  
Iron Status ◽  
Ferritin Level ◽  
Venous Blood ◽  
Transferrin Saturation ◽  
Adolescent Athletes ◽  
Male And Female ◽  
Tennis Players ◽  
Iron Stores

Much attention has focused on the nutrition and hematological profile of female athletes, especially gymnasts. The few studies on iron status of male adolescent athletes found a low incidence of iron deficiency. The present study investigated the iron status of male and female gymnasts (G) and compared it with athletes of other sports. Subjects were 68 elite athletes (43 M, 25 F) ages 12-18, of four sports: gymnasts (11 M, 12 F), swimmers (11 M, 6 F), tennis players (10 M, 4 F), and table tennis players (11 M, 3 F). All lived in the national center for gifted athletes, trained over 25 hr a week, ate in the same dining room, and shared a similar lifestyle. Mean levels of hemoglobin (Hb), red blood cell indexes, serum ferritin, serum iron, and transferrin were measured in venous blood. There was no difference in mean Rb among gymnasts (G) and nongymnasts (NG). However, Hb was less than 14 g/dL in 45% of M G vs. only 25% in NG, and less than 13 g/dL in 25% of premenarcheal FG vs. 15% in NG. Low transferrin saturation (< 20%) was detected in 18% of M G and 25% of FG vs. 6% and 8% in male and female NG, respectively (p < .05). The percentage of males suffering from low ferritin level (< 20 ng/ml) was twice as high in G (36%) vs. NG (19%), and about 30% in all females. In summary, iron stores were consistently lower in M G vs. NG. Adolescent athletes of both genders, G in particular, are prone to nonanemic iron deficiency, which might compromise their health and athletic performance.

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