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

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<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.

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Evaluation of Iron Status by Bone Marrow Iron Stain and its Correlation with Serum Iron Profile in Chronic Kidney Disease (CKD)

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v25i3.406 ◽

1970 ◽

Vol 25 (3) ◽

pp. 117-120 ◽

Cited By ~ 3

Author(s):

Md Mahbubur Rahman ◽

Pradip Kumar Dutta ◽

Mahmudul Hoque ◽

Md Iftikher Hossain Han ◽

Dhiman Banik ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Bone Marrow ◽

Kidney Disease ◽

Serum Ferritin ◽

Serum Iron ◽

Iron Status ◽

Tissue Iron ◽

Bone Marrow Iron ◽

The Mean ◽

Iron Profile

This observational study was done on 52 cases of predialysis chronic kidney disease (CKD) patients with chronic anaemia. The aim of the study was to determine the tissue iron status, comparison of the tissue iron with serum iron profile and justification of giving iron in chronic kidney disease (CKD) patients on the basis of serum iron profile. Bone marrow iron stain was done in each case and compared with the serum iron profile. The mean age of the patients was 46.8 ± 12.6 years and the mean haemoglobin and serum creatinine levels of the study population were 9.36 ± 2.13 gm/dl and 8.0 ± 4.2 mg/dl respectively. Stainable iron deposits were present in 40 (77%) cases. The mean serum ferritin and transferin saturation (TSAT) of the 52 cases were found to be 412.9 ng/ml and 28.3% and that for the 12 iron deficient cases were 101.8 ng/ml and 23.8%. Over all normal (>100ng/ml <500ng/ml), increased (>500ng/ml) or low (>100 ng/ml) serum ferritin was found in 28 and 15 and nine cases respectively. On the other hand, normal (>20% >50%) and low (>20%) TSAT were found in 31 and 12 cases, and high TSAT (>50%) in only nine cases. Out of the 12 cases having no evidence of stainable iron in the marrow low serum ferritin and low TSAT were found in eight (66.6%) and six (50%) cases, and high TSAT and either normal or high serum ferritin in six (50%) & four (33.3%) cases respectively. Low TSAT was also found in six (15%) cases of those having iron deposits in the marrow. It is, therefore, concluded that absence of stainable iron in the bone marrow is a better evidence of iron depletion than the serum iron profile and that serum ferritin and TSAT correlate less well with the bone marrow iron status in patient with chronic kidney disease. (J Bangladesh Coll Phys Surg 2007; 25 : 117-120)

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Clinical profile of patients with anemia

Journal of Institute of Medicine ◽

10.3126/jiom.v31i3.2994 ◽

1970 ◽

Vol 31 (3) ◽

pp. 30-33 ◽

Cited By ~ 1

Author(s):

K. S. Lamsal

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Chronic Renal Failure ◽

Kidney Disease ◽

Iron Deficiency ◽

Blood Smear ◽

Peripheral Blood Smear ◽

Gi Bleeding ◽

Blood Picture ◽

Medical Wards

Introduction: Anemia itself is not a disease but a clinical feature of some other underlying problems and leads to hypoxia and a wide range of clinical consequences. In a tertiary center like Tribhuvan University Teaching Hospital (TUTH), many patients admitted in medical wards have low hemoglobin. The objective of this study is to determine the etiology and evaluate the different components of clinical profile of the patients having anemia in medical wards of TUTH. Methods: Patients having hemoglobin less than 10 in the medical wards of TUTH were enrolled in the study. Estimation of hemoglobin and other investigations were done in hematology lab of TUTH. Data were obtained by history taking, examination findings and investigation reports and analysis was done by statistical software SPSS 11.5v. Results: Among the 237 patients, 138 were male and 99 were female. The commonest age group was 40-49 years. The average hemoglobin was 7.8gm%, the lowest being 2.8gm%. Peripheral blood smear showed hypochromic picture in 140, macrocytic picture in 26 and the morphology was normocytic normochromic in 71 cases. Variceal bleeding leading to anemia was seen in 52, NSAID induced GI bleeding in 22 , peptic ulcer in 18, hookworm infestation in 6, nutritional iron deficiency and anemia of chronic diseases in remaining cases. Among the 26 cases having macrocytic anemia, 11 had megaloblastic changes in bone marrow examination and 6 had vitamin B 12deficiency and 5 had folate deficiency. Among the 71 patients having normocytic normochromic blood picture, 8 had hemolytic anemia, 11 had aplastic anemia and remaining were having anemia of chronic disease mainly chronic kidney disease. Regarding treatment, 84 patients were transfused blood. Out of total 237 patients included in the study, in-hospital mortality was 28. Conclusions: Anemia is associated with a variety of diseases. As chronic blood loss and iron deficiency are among the leading causes of anemia, hypochromic and microcytic picture was the predominant picture in peripheral blood smear. Among the patients having normocytic normochromic blood picture, majority were having chronic kidney disease which may be due to the fact that TUTH is a tertiary referral centre for chronic renal failure. In-hospital mortality due to anemia alone is lower in tertiary care centers, but the mortality in our study is due to associated co-morbid conditions like chronic renal failure and variceal upper GI bleeding. Keywords: Anemia, hemoglobin, iron deficiency. DOI: 10.3126/joim.v31i3.2994 Journal of Institute of Medicine, December, 2009; 31(3) 30-33

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Pancytopenia: A Challenging Problem for Treating Physician

Haematology Journal of Bangladesh ◽

10.37545/haematoljbd201814 ◽

2018 ◽

Vol 2 (01) ◽

pp. 22-28

Author(s):

Md. Rezaul Karim Chowdhury ◽

Amina Begum ◽

Md. Haroon Ur Rashid ◽

Md. Kamrul Hasan

Keyword(s):

Bone Marrow ◽

Physical Examination ◽

Blood Smear ◽

Peripheral Blood Smear ◽

Bone Marrow Examination ◽

Challenging Problem ◽

Trephine Biopsy ◽

Life Threatening ◽

Underlying Pathology ◽

Careful History

Pancytopenia is an important clinico-haematological entity and striking feature of many serious and life-threatening illnesses. Many haematological and non-haematological diseases involve the bone marrow primarily or secondarily and cause pancytopenia. Decrease in haemopoietic cell production, ineffective haemopoiesis and peripheral sequestration or destruction of the cells are the main pathophysiology of pancytopenia. The cause of pancytopenia thus may be lying in the bone marrow or in the periphery or both. Careful history, physical examination, simple blood work, review of the peripheral blood smear, sometimes bone marrow examination and trephine biopsy are required for diagnosis. Treatment and prognosis depend on the severity of pancytopenia and underlying pathology.

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Iron preparations for children

Drug and Therapeutics Bulletin ◽

10.1136/dtb.4.3.9 ◽

1966 ◽

Vol 4 (3) ◽

pp. 9-11

Keyword(s):

Bone Marrow ◽

Iron Deficiency ◽

Blood Smear ◽

Binding Capacity ◽

Iron Binding ◽

Iron Stores ◽

Plasma Iron ◽

Hypochromic Anaemia ◽

Iron Binding Capacity

We have discussed iron preparations for adults in earlier articles;1 much of the information applies equally to children. Iron is not a ‘tonic’ and should be given only to prevent or correct iron deficiency. Estimation of the haemoglobin and inspection of a blood smear are the minimum investigations necessary before iron is prescribed in therapy. When deficiency is suspected in the absence of hypochromic anaemia, plasma iron and iron-binding capacity should be estimated and/or the bone marrow examined for haemosiderin crystals which disappear when iron stores are depleted.

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MO547ASSOCIATION BETWEEN SERUM INDICES OF IRON METABOLISM AND CARDIOVASCULAR MORBIDITY IN PATIENTS WITH PREDIALYSIS CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab085.0010 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Takeshi Hasegawa ◽

Takahiro Imaizumi ◽

Kenta Murotani ◽

Takayuki Hamano ◽

Masafumi Fukagawa

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Metabolism ◽

Iron Supplementation ◽

Transferrin Saturation ◽

Cox Proportional Hazards ◽

Function Evaluation ◽

Iron Deficient ◽

Increased Risk ◽

Reduced Risk

Abstract Background and Aims Patients with predialysis chronic kidney disease (CKD) have a greater risk of developing cardiovascular disease (CVD) events than the general population. Anaemia is the most frequent comorbidity in pre-dialysis CKD patients and is associated with an increase in CVD events. Iron deficiency is the most frequent cause of erythropoiesis-stimulating agents (ESAs) resistant anaemia in CKD patients and is modifiable by therapeutic intervention. However, the optimal ranges of iron markers are uncertain in predialysis CKD patients. Therefore, we aimed to investigate the association between serum indices of iron metabolism and the incidence of CVD events in patients with predialysis CKD using the CKD-Japan Cohort (CKD-JAC) data. Method We prospectively followed 1550 CKD patients aged 20-75 years with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 for a mean of 4.21 years. We set serum transferrin saturation (TSAT) and ferritin levels as the main exposures to be tested. Our main outcome measures were any of the CVD events including fatal or non-fatal myocardial infarction, congestive heart failure (CHF), angina pectoris, arrhythmia, aorta dissection, cerebrovascular disorder, and peripheral artery diseases identified at each facility and adjudicated by the independent cardiac function evaluation committee. Multivariable Cox proportional hazards regression models were employed to examine the association between serum TSAT or ferritin levels with time to events. Death was considered as a competing risk with the Fine and Gray model. All models were stratified by facilities and adjusted for potential confounders as follows: age, sex, systolic blood pressure, diabetes mellitus, history of CHF, haemoglobin, serum calcium, serum phosphorus, intact parathyroid hormone, eGFR, proteinuria, ESAs, iron supplementation, renin-angiotensin system inhibitors, and beta-blockers. We also applied the multivariable fractional polynomial interaction (MFPI) approach to investigate whether TSAT levels are the effect modifier of the association between iron supplementation and the outcomes. Results In the overall cohort, 208 (13.4 %) patients developed CVD events (including 97 CHF) during the follow-up period (26.6 events/1000 person-year). The incidence rate of CVD events was the highest in the TSAT < 20% category (33.0 events/1000 person-year). Compared to patients in the TSAT > 40% category, those in the TSAT < 20% category demonstrated an increased risk of CVD events (adjusted hazard ratio (AHR): 1.86, 95% confidence interval (CI): 1.06-3.26) and CHF events (AHR: 2.82, 95% CI: 1.15-6.89), respectively. Meanwhile, there was no association between serum ferritin levels and the risk of developing CVD or CHF events. MFPI analyses showed a reduced risk of CVD in patients receiving iron supplementation only in patients with TSAT <20% (P for interaction=0.02). Conclusion Maintaining TSAT >20% could be effective to reduce the risk of developing CVD events (especially CHF) in patients with predialysis CKD. Our analyses also suggest that iron-deficient patients with predialysis CKD may benefit from iron supplementation for reduced risk of CVD events.

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MO794EVALUATION OF THE BONE ELASTIC STRUCTURE IN PERSONS WITH AND WITHOUT CHRONIC KIDNEY DISEASE ON DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab096.003 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Pietro Manuel Ferraro ◽

Alessandra Nicolosi ◽

Alessandro Naticchia ◽

Nicola Panocchia ◽

Giuseppe Grandaliano ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Linear Regression ◽

Bone Structure ◽

Bone Fractures ◽

Elastic Structure ◽

Absolute Difference ◽

P Value ◽

Non Invasive ◽

Age And Sex

Abstract Background and Aims Chronic kidney disease is a frequent condition, characterized, especially in its more advanced stages, by an array of derangements in bone structure and density, resulting in a higher rate of bone fractures. Current strategies to monitor the bone status and assess the risk of bone fractures in CKD patients are limited. The Bone Elastic Structure (BES) test is a recently-developed non-invasive tool that measures the elastic characteristics of the trabecular bone by simulating the application of loads on a virtual biopsy obtained from radiographic images of the proximal epiphyses in the patient’s hand fingers. The simulation results are combined to obtain a parameter defined Bone Structure Index (BSI). The aim of our study is to explore whether the BES test could be a useful monitoring tool of bone status in patients with CKD on dialysis by exploring whether such patients have different BSI values compared with persons without CKD. Method The BES test was performed on a sample of 41 patients undergoing chronic hemodialysis (HD) and the BSI compared with a group of 374 persons with normal renal function who had undergone the BES test in previous studies. Differences in BSI and 95% confidence intervals (CIs) between the two groups were obtained and tested for statistical significance with a linear regression model including BSI as the dependent variable and kidney status (HD vs no HD) as the independent variable, adjusted for age and sex. Subgroup effects were explored by including interaction terms (age x kidney status, age x sex, kidney status x sex) in the model. Finally, to further remove the potential confounding by age and sex, each HD patient was individually matched with up to 4 non-HD participants based on sex and age (with a 5-year caliper) and a matched analysis was conducted on BSI values. Results Average (SD) age was 64 (17) years in the HD group and 60 (12) years in the non-HD group, with a prevalence of males of 49% and 16%, respectively. The individual values of BSI divided by kidney status and sex in Figure. The multivariate linear regression model showed that, after adjustment for age and sex, the BSI in the HD group was significantly lower compared with the non-HD group (HD 145, 95% CI 140, 154; non-HD 179, 95% CI 177, 181; absolute difference −32, 95% CI −40, −25; p-value < 0.001). There was no significant interaction between age, sex and kidney status on BSI values (all p-values > 0.05). Individual matching was successful for 36 out of 41 HD patients, who were matched to 127 non-HD participants; matched analysis confirmed the results (absolute difference −31, 95% CI −40, −23; p-value < 0.001). Conclusion The output of a non-invasive tool to determine the bone elastic structure appeared to be strongly associated with kidney function after control for differences in age and sex. Further studies are needed to determine the potential application of the BES test in patients with CKD.

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Correlation of Iron Profile with Different Stages of Chronic Kidney Disease in Children Presenting at a Tertiary Care Hospital

10.53350/pjmhs211582013 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2013-2016

Author(s):

Shahid Ishaq ◽

Muhammad Imran ◽

Hashim Raza ◽

Khuram Rashid ◽

Muhammad Imran Ashraf ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Overload ◽

Serum Ferritin ◽

Serum Iron ◽

Tertiary Care ◽

Transferrin Saturation ◽

Maintenance Hemodialysis ◽

Care Hospital ◽

Iron Profile

Aim: To determine correlation of iron profile in children with different stages of chronic kidney disease (CKD) presenting to tertiary care hospital. Methodology: A total of 81 children with chronic kidney disease stage having glomerular filtration rate (GFR) less than 90 (ml/min/m2) aged 1 – 14 years of either sex were included. Three ml serum sample was taken in vial by hospital duty doctor for serum ferritin level, serum iron, transferrin saturation and total iron binding capacity. The sample was sent to hospital laboratory for reporting. Iron profiling was done evaluating hemoglobin (g/dl), serum iron (ug/dl), serum ferritin (ng/ml), transferrin saturation (%) and total iron binding capacity (ug/dl) while iron load was defined as serum ferritin levels above 300 ng/ml. Correlation of iron profile with different stages of CKD was determined applying one-way analysis of variance (ANOVA). Results: In a total 81 children, 46 (56.8%) were boys while overall mean age was 7.79±2.30 years. Mean duration on hemodialysis was 11.52 ± 9.97 months. Iron overload was observed in 26 (32.1%) children. Significant association of age above 7 years (p=0.031) and residential status as rural (p=0.017) was noted with iron overload whereas iron overload was increasing with increase in stages of CKD (p=0.002). Hemoglobin levels decreased significantly with increase in stages of CKD (p<0.001). Serum iron levels increased significantly with increase in the CKD stages (p=0.039). Serum ferritin levels were increasing significantly with the increase in CKD stages (p=0.031). Transferrin saturation also increased significant with increase in CKD stages (p=0.027). Conclusion: High frequency of iron overload was noted in children with CKD on maintenance hemodialysis and there was linear relationship with stages of CKD and iron overload. Significant correlation of hemoglobin, serum iron, serum ferritin and transferrin saturation was observed with different stages of CKD. Keywords: Iron overload, maintenance hemodialysis, ferritin level.

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Paracrine Proangiogenic Function of Human Bone Marrow-Derived Mesenchymal Stem Cells Is Not Affected by Chronic Kidney Disease

Stem Cells International ◽

10.1155/2019/1232810 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Femke C. C. van Rhijn-Brouwer ◽

Bas W. M. van Balkom ◽

Diana A. Papazova ◽

Diënty H. M. Hazenbrink ◽

Anke J. Meijer ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Bone Marrow ◽

Kidney Disease ◽

Kidney Transplant ◽

Galactosidase Activity ◽

Kidney Transplant Recipients ◽

Paracrine Factors ◽

Differentiation Capacity ◽

Scratch Wound

Background. Cell-based therapies are being developed to meet the need for curative therapy in chronic kidney disease (CKD). Bone marrow- (BM-) derived mesenchymal stromal cells (MSCs) enhance tissue repair and induce neoangiogenesis through paracrine action of secreted proteins and extracellular vesicles (EVs). Administration of allogeneic BM MSCs is less desirable in a patient population likely to require a kidney transplant, but potency of autologous MSCs should be confirmed, given previous indications that CKD-induced dysfunction is present. While the immunomodulatory capacity of CKD BM MSCs has been established, it is unknown whether CKD affects wound healing and angiogenic potential of MSC-derived CM and EVs. Methods. MSCs were cultured from BM obtained from kidney transplant recipients (N=15) or kidney donors (N=17). Passage 3 BM MSCs and BM MSC-conditioned medium (CM) were used for experiments. EVs were isolated from CM by differential ultracentrifugation. BM MSC differentiation capacity, proliferation, and senescence-associated β-galactosidase activity was assessed. In vitro promigratory and proangiogenic capacity of BM MSC-derived CM and EVs was assessed using an in vitro scratch wound assay and Matrigel angiogenesis assay. Results. Healthy and CKD BM MSCs exhibited similar differentiation capacity, proliferation, and senescence-associated β-galactosidase activity. Scratch wound migration was not significantly different between healthy and CKD MSCs (P=0.18). Healthy and CKD BM MSC-derived CM induced similar tubule formation (P=0.21). There was also no difference in paracrine regenerative function of EVs (scratch wound: P=0.6; tubulogenesis: P=0.46). Conclusions. Our results indicate that MSCs have an intrinsic capacity to produce proangiogenic paracrine factors, including EVs, which is not affected by donor health status regarding CKD. This suggests that autologous MSC-based therapy is a viable option in CKD.

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Is Transferrin Saturation a Useful Marker of Iron Metabolism in Patients with Chronic Kidney Disease Treated with Hemodialysis?

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01912010077 ◽

2019 ◽

Vol 12 (1) ◽

pp. 77-82

Author(s):

Ewa Kwiatkowska ◽

Martyna Opara ◽

Sebastian Kwiatkowski ◽

Leszek Domański ◽

Małgorzata Marchelek-Myśliwiec ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Metabolism ◽

Complete Blood Count ◽

Transferrin Saturation ◽

Maintenance Hemodialysis ◽

Study Group ◽

Ferritin Concentration ◽

Lower Limit Of Normal

Background: According to the currently applicable KDIGO-2012 and ERBP 2013 guidelines, iron metabolism assessments for patients with Chronic Kidney Disease (CKD) are performed using such parameters as ferritin concentration and Transferrin Saturation (TSAT). Their values are to be treated as a basis on which to decide on providing iron substitution. Patients with Stage 5 CKD on maintenance hemodialysis commonly suffer from malnutrition syndrome and inflammation. One of the markers for malnutrition and inflammation is low transferrin concentration. Our study focused on establishing what percentage of patients this applied to and whether or not the transferrin saturation figure was artificially inflated in such cases. Materials and Methods: The study group included 66 patients with Stage 5 CKD on maintenance hemodialysis. Such data were analyzed as complete blood count, iron and ferritin concentrations, and Transferrin Saturation (TSAT). Other parameters - age, sex, time from their first hemodialysis, and the quality of their dialysis in the last six months – the Kt/V average. Results: It was found that only 12% of the study group patients had their transferrin concentrations above the lower limit of normal. The TSAT value correlated negatively with transferrin concentration. Transferrin concentration correlated negatively with time from first hemodialysis or ferritin concentration, and positively with body weight. Normal transferrin concentration was only seen in patients with ferritin concentrations of up to 400 μg/L. The group was divided according to transferrin concentration of <1.5 g/L or >1.5 g/L. These groups differed significantly in ferritin concentration and transferrin saturation. (p = 0.0005 and p = 0.004, respectively). The 1.5 g/L transferrin concentration point divides patients with mild and medium malnutrition. It is also the minimum transferrin content necessary to achieve hemoglobin values ≥10 g/dL determined using the ROC curve. Conclusion: Low transferrin concentrations cause abnormally high TSAT values. In most patients on maintenance hemodialysis, this marker is not useful for assessing the availability of iron for erythropoiesis.

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