FP655LOW LEVELS OF SERUM FERRITIN WITH MODERATE LEVEL OF TRANSFERRIN SATURATION MAINTAINS ADEQUATE HEMOGLOBIN IN HEMODIALYSIS PATIENTS

Abstract Background Chronic kidney disease (CKD) is associated with several comorbidities, including anemia, since with decreased renal function there is a decrease in erythropoietin (EPO) production and changes in iron (Fe) metabolism. In hemodialysis patients, prescription of Fe is indicated to supplement the needs of this element by maintaining ferritin levels above 100 mg/dl and transferrin saturation greater than 20%. However, the excess of Fe can generate free Fe not bound to transferrin, and deposit in organs such as liver, heart, and bone marrow, with consequent impairment of their function. In hemodialysis patients, the diagnosis of Fe overload, its clinical significance and therapeutic decision have been poorly studied, unlike thalassemia patients. Aims To assess whether hemodialysis patients with ferritin levels equal to or greater than 1000 mg/l also have Fe overload in liver, heart, and bone marrow, as well as compromise bone density and remodeling. Method This is a cross-sectional analysis that included 28 adult patients on regular conventional hemodialysis. Inclusion criteria were serum levels of ferritin ≥ 1000 mg/l, and ESRD treated by regular hemodialysis for at least 6 months. We excluded patients with HIV, cancer, hepatic disease, patients who received desferroxamine in the latest year, and those previously submitted to a kidney transplant. All patients underwent dual-energy X-ray absorptiometry (DXA), serum ferritin, transferrin saturation index (STI), Fe, C reactive protein (CRP), Calcium(Ca), phosphorus (P), parathyroid hormone (PTH) and alkaline phosphatase (AP) levels were recorded. T2* image acquisition of Magnetic Resonance Imaging (MRI) 1,5 Tesla, were used for the assessment of Fe of liver, and heart. R2* and R2* Water were used of liver and bone (iliac crest). Bone biopsy was also performed. Results We evaluated 28 hemodialysis patients with a mean age of 55.8±13.1, hemodialysis time of 42.5±26.5 and iron use in the year prior to study enrollment of 311.5±179.8 mg/month. Biochemical analysis showed 3 patients with Hb below 9.0 mg/dl and 14 with values above 11.5 mg/dl; 6 patients with SatFe <30% and 12 patients with ferritin >1500mg/dl; 16 patients with PTH <300pg/ml and eight with >600pg/dl. MRI revealed Fe overload in the liver and bone tissue (figure 1) of all patients but not in the heart. Serum ferritin levels correlated with liver and bone overload (figure 2). Densitometry and bone biopsy results were not affected by Fe overload, however, serum Fe levels were associated with lower bone remodeling and mineralization suggesting an effect of this element on osteoblast activity. Conclusion High serum ferritin is associated with liver and bone marrow Fe overload, but not heart, as well as with low bone remodeling and mineralization. We must be aware of these side effects of high doses of Fe that are commonly used in these patients.

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183: Profiles of Serum Ferritin and Transferrin Saturation Following Administration of Two IV Iron Formulations to Hemodialysis Patients

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2008.02.192 ◽

2008 ◽

Vol 51 (4) ◽

pp. B73

Author(s):

Timothy Nguyen

Keyword(s):

Serum Ferritin ◽

Transferrin Saturation ◽

Hemodialysis Patients ◽

Iv Iron

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Predictors of the response to treatment in anemic hemodialysis patients with high serum ferritin and low transferrin saturation

Kidney International ◽

10.1038/sj.ki.5002223 ◽

2007 ◽

Vol 71 (11) ◽

pp. 1163-1171 ◽

Cited By ~ 65

Author(s):

A.K. Singh ◽

D.W. Coyne ◽

W. Shapiro ◽

A.R. Rizkala ◽

the DRIVE Study Group

Keyword(s):

Serum Ferritin ◽

Transferrin Saturation ◽

Hemodialysis Patients ◽

High Serum ◽

Response To Treatment

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Optimization of Epoetin Therapy with Intravenous Iron Therapy in Hemodialysis Patients

Journal of the American Society of Nephrology ◽

10.1681/asn.v113530 ◽

2000 ◽

Vol 11 (3) ◽

pp. 530-538

Author(s):

ANATOLE BESARAB ◽

NEETA AMIN ◽

MUHAMMAD AHSAN ◽

SUSAN E. VOGEL ◽

GARY ZAZUWA ◽

...

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Transferrin Saturation ◽

Intravenous Iron ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Control Group ◽

Zinc Protoporphyrin ◽

Study Group ◽

Iron Deficient

Abstract. Iron deficiency limits the efficacy of recombinant human erythropoietin (rhEPO) therapy in end-stage renal disease (ESRD) patients. Functional iron deficiency occurs with serum ferritin >500 ng/ml and/or transferrin saturation (TSAT) of 20 to 30%. This study examines the effects of a maintenance intravenous iron dextran (ivID) protocol that increased TSAT in ESRD hemodialysis patients from conventional levels of 20 to 30% (control group) to those of 30 to 50% (study group) for a period of 6 mo. Forty-two patients receiving chronic hemodialysis completed a 16- to 20-wk run-in period, during which maintenance ivID and rhEPO were administered in amounts to achieve average TSAT of 20 to 30% and baseline levels of hemoglobin of 9.5 to 12.0 g/dl. After the run-in period, 19 patients randomized to the control group received ivID doses of 25 to 150 mg/wk for 6 mo. Twenty-three patients randomized to the study group received four to six loading doses of ivID, 100 mg each, over a 2-wk period to achieve a TSAT >30% followed by 25 to 150 mg weekly to maintain TSAT between 30 and 50% for 6 mo. Both regimens were effective in maintaining targeted hemoglobin levels. Fifteen patients in the control group and 17 patients in the study group finished the study in which the primary outcome parameter by intention to treat analysis was the rhEPO dose needed to maintain prestudy hemoglobin levels. Maintenance ivID requirements in the study group increased from 176 to 501 mg/mo and were associated with a progressive increase in serum ferritin to 658 ng/ml. Epoetin dose requirements for the study group decreased by the third month and remained 40% lower than for the control group, resulting in an overall cost savings in managing the anemia. Secondary indicators of iron-deficient erythropoiesis were also assessed. Zinc protoporphyrin did not change in either group. Reticulocyte hemoglobin content increased only in the study group from 28.5 to 30.1 pg. It is concluded that maintenance of TSAT between 30 and 50% reduces rhEPO requirements significantly over a 6-mo period.

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Low levels of serum ferritin and moderate transferrin saturation lead to adequate hemoglobin levels in hemodialysis patients, retrospective observational study

PLoS ONE ◽

10.1371/journal.pone.0179608 ◽

2017 ◽

Vol 12 (6) ◽

pp. e0179608 ◽

Cited By ~ 10

Author(s):

Chie Ogawa ◽

Ken Tsuchiya ◽

Naohisa Tomosugi ◽

Fumiyoshi Kanda ◽

Kunimi Maeda ◽

...

Keyword(s):

Observational Study ◽

Serum Ferritin ◽

Transferrin Saturation ◽

Hemodialysis Patients ◽

Retrospective Observational Study ◽

Low Levels

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The evaluation of iron status in hemodialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v7122654 ◽

1996 ◽

Vol 7 (12) ◽

pp. 2654-2657 ◽

Cited By ~ 2

Author(s):

S Fishbane ◽

E A Kowalski ◽

L J Imbriano ◽

J K Maesaka

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Marginal Utility ◽

Iron Status ◽

Transferrin Saturation ◽

Hemodialysis Patients ◽

Mean Cell Volume ◽

Distribution Width ◽

Baseline Serum ◽

Significant Difference

Effective treatment of anemia in hemodialysis patients requires ongoing monitoring of iron status. The purpose of this study was to determine levels of commonly used iron indices predictive of iron deficiency in this population. Forty-seven patients with baseline serum ferritin levels < 600 ng/mL were treated with intravenous iron dextran (INFeD; Schein Pharmaceutical Inc., Florham Park, NJ), 1000 mg over ten hemodialysis treatments. Patients whose hematocrit value increased by 5% or who had a 10% decrease in their erythropoietin dose by 2 months were classified as having iron deficiency (N = 31; 66%). All other subjects were classified as having adequate iron (N = 16; 34%). There was no statistically significant difference in baseline serum ferritin, transferrin saturation, mean cell volume, mean cell hemoglobin content, or red cell distribution width between the two groups. Receiver operator curves demonstrated that none of the iron indices had a high level of utility (both sensitivity and specificity > 80%). Two tests had marginal utility, serum ferritin at a level of < 150 ng/mL, and transferrin saturation < 21%. It was concluded that because of the tests' marginal utility, they should only be interpreted in the context of the patient's underlying erythropoietin, responsiveness. In patients who are responsive to erythropoietin, a transferrin saturation value < 18% or serum ferritin level < 100 ng/mL should be used to indicate inadequate iron. When erythropoietin resistance is present, transferrin saturation of < 27% or serum ferritin < 300 ng/mL should be used to guide iron management.

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