Iron Status of Dialysis Patients under rhuEPO Therapy

Abstract Background and Aims Transferrin saturation (TSAT) is an indicator of iron deficiency or overload, but its relationship with mortality in patients with different stages of chronic kidney disease (CKD) is unclear. We investigated the association of TSAT with mortality in CKD patients. Method In 479 CKD patients (97 CKD3-4 patients, 298 CKD5 non-dialysis patients and 84 peritoneal dialysis patients; median age 58 years, 67% males, 33% cardiovascular disease, CVD, and 29% diabetes), biomarkers of iron status (plasma iron, TSAT, transferrin and ferritin), systemic inflammation (high sensitivity C-reactive protein, hsCRP, and interleukin-6, IL-6) and nutritional status were assessed. During median follow-up of 35.6 months, 139 (29%) patients died, and 176 (37%) patients underwent renal transplantation. Patients were stratified into low (n=157) and high (n=322) TSAT tertile groups. All-cause and CVD mortality risk were analyzed with competing risk regression with renal transplantation as competing risk. Results TSAT [median 23% (IQR 17-30%)] was negatively associated with presence of DM and CVD, body mass index, hsCRP, IL-6, Framingham´s CVD risk score (FRS), erythropoietin resistance index (ERI) and iron supplementation, and positively associated with hemoglobin, ferritin and s-albumin. In competing risk analysis, low tertile of TSAT was independently associated with increased all-cause mortality risk (sHR=1.50, 95%CI 1.05-2.14) after adjusting for CKD stages, 1-SD of FRS, 1-SD of hemoglobin, 1-SD of hsCRP, 1-SD of ESA dose and iron supplementation (Figure 1). Conclusion TSAT was inversely associated with mortality risk in CKD patients. When evaluating clinical outcomes of CKD patients, iron status using TSAT as a predictive marker, should be considered.

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Erythropoietin, iron, and erythropoiesis

Blood ◽

10.1182/blood.v96.3.823 ◽

2000 ◽

Vol 96 (3) ◽

pp. 823-833 ◽

Cited By ~ 225

Author(s):

Lawrence T. Goodnough ◽

Barry Skikne ◽

Carlo Brugnara

Keyword(s):

Blood Loss ◽

Iron Status ◽

Renal Dialysis ◽

Intravenous Iron ◽

Dialysis Patients ◽

Oral Supplementation ◽

Human Erythropoietin ◽

Intravenous Iron Therapy ◽

The Relationship ◽

Serum Erythropoietin

Abstract Recent knowledge gained regarding the relationship between erythropoietin, iron, and erythropoiesis in patients with blood loss anemia, with or without recombinant human erythropoietin therapy, has implications for patient management. Under conditions of significant blood loss, erythropoietin therapy, or both, iron-restricted erythropoiesis is evident, even in the presence of storage iron and iron oral supplementation. Intravenous iron therapy in renal dialysis patients undergoing erythropoietin therapy can produce hematologic responses with serum ferritin levels up to 400 μg/L, indicating that traditional biochemical markers of storage iron in patients with anemia caused by chronic disease are unhelpful in the assessment of iron status. Newer measurements of erythrocyte and reticulocyte indices using automated counters show promise in the evaluation of iron-restricted erythropoiesis. Assays for serum erythropoietin and the transferrin receptor are valuable tools for clinical research, but their roles in routine clinical practice remain undefined. The availability of safer intravenous iron preparations allows for carefully controlled studies of their value in patients undergoing erythropoietin therapy or experiencing blood loss, or both.

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Inverse association of transferrin saturation with mortality risk in chronic kidney disease

10.21203/rs.3.rs-20186/v1 ◽

2020 ◽

Author(s):

Xin Li ◽

Kristin Danielson ◽

Innas Forsal ◽

Ken Iseri ◽

Lu Dai ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Transplantation ◽

Kidney Disease ◽

Mortality Risk ◽

Iron Supplementation ◽

Iron Status ◽

Transferrin Saturation ◽

Competing Risk ◽

Dialysis Patients ◽

Cvd Mortality

Abstract Background: Transferrin saturation (TSAT) is an indicator of iron deficiency or overload, but its relationship with mortality in patients with different stages of chronic kidney disease (CKD) is unclear. We investigated the association of TSAT with mortality in CKD patients. Methods: In 479 CKD patients (97 CKD3-4 patients, 298 CKD5 non-dialysis patients and 84 peritoneal dialysis patients; median age 58 years, 67% males, 33% cardiovascular disease, CVD, and 29% diabetes), biomarkers of iron status (plasma iron, TSAT, transferrin and ferritin), systemic inflammation (high sensitivity C-reactive protein, hsCRP, and interleukin-6, IL-6) and nutritional status were assessed. During median follow-up of 35.6 months, 139 (29%) patients died, and 176 (37%) patients underwent renal transplantation. Patients were stratified into Low (n=157) and Middle and high (n=322) TSAT tertile groups. All-cause and CVD mortality risk were analyzed by competing risk regression with renal transplantation as competing risk. Results: TSAT (median 23%; interquartile range, 17-30%) was negatively associated with presence of diabetes and CVD, body mass index, hsCRP, IL-6, erythropoiesis stimulating agent (ESA) dose, erythropoietin resistance index (ERI) and iron supplementation, and positively associated with hemoglobin, ferritin and s-albumin. In competing risk analysis, low tertile of TSAT was independently associated with increased all-cause mortality risk (sHR=1.74, 95%CI 1.30-2.54) and CVD mortality risk (sHR=1.80, 95%CI 1.02-3.16) after fully adjusting for 1-standard deviation (SD) of age, sex, CKD stages, 1-SD of hemoglobin, 1-SD of ferritin, 1-SD of hsCRP, 1-SD of ESA dose and iron supplementation. Conclusions: Lower TSAT indicating iron deficiency was independently associated with increased mortality risk in CKD patients, underlining that iron status should be considered when evaluating clinical outcomes of CKD patients.

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About the Role of Prohepcidin as an Indicator of Iron Status in Dialysis Patients

Therapeutic Apheresis and Dialysis ◽

10.1111/j.1744-9987.2008.00604.x ◽

2008 ◽

Vol 12 (5) ◽

pp. 421-422

Author(s):

Theodoros Eleftheriadis ◽

Vassilios Liakopoulos ◽

Charalambos Kartsios ◽

Georgia Antoniadi ◽

Sotirios Zarogiannis ◽

...

Keyword(s):

Iron Status ◽

Dialysis Patients

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Erythropoietin, iron, and erythropoiesis

Blood ◽

10.1182/blood.v96.3.823.015k49_823_833 ◽

2000 ◽

Vol 96 (3) ◽

pp. 823-833 ◽

Cited By ~ 4

Author(s):

Lawrence T. Goodnough ◽

Barry Skikne ◽

Carlo Brugnara

Keyword(s):

Blood Loss ◽

Iron Status ◽

Renal Dialysis ◽

Intravenous Iron ◽

Dialysis Patients ◽

Oral Supplementation ◽

Human Erythropoietin ◽

Intravenous Iron Therapy ◽

The Relationship ◽

Serum Erythropoietin

Recent knowledge gained regarding the relationship between erythropoietin, iron, and erythropoiesis in patients with blood loss anemia, with or without recombinant human erythropoietin therapy, has implications for patient management. Under conditions of significant blood loss, erythropoietin therapy, or both, iron-restricted erythropoiesis is evident, even in the presence of storage iron and iron oral supplementation. Intravenous iron therapy in renal dialysis patients undergoing erythropoietin therapy can produce hematologic responses with serum ferritin levels up to 400 μg/L, indicating that traditional biochemical markers of storage iron in patients with anemia caused by chronic disease are unhelpful in the assessment of iron status. Newer measurements of erythrocyte and reticulocyte indices using automated counters show promise in the evaluation of iron-restricted erythropoiesis. Assays for serum erythropoietin and the transferrin receptor are valuable tools for clinical research, but their roles in routine clinical practice remain undefined. The availability of safer intravenous iron preparations allows for carefully controlled studies of their value in patients undergoing erythropoietin therapy or experiencing blood loss, or both.

Download Full-text