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Association between transferrin receptor-ferritin index and conventional measures of iron responsiveness in hemodialysis patients.
Am J Kidney Dis. 2006 Jun; 47(6):1036-44.AJ

Abstract

BACKGROUND

The diagnostic power of the transferrin receptor-ferritin (TfR-F) index for identification of iron responsiveness in long-term hemodialysis (HD) patients compared with the routine markers recommended by the current US and European guidelines was appraised.

METHODS

Initially, 121 long-term HD patients with a serum ferritin level less than 800 microg/L and on recombinant erythropoietin (rHuEPO) therapy for longer than 6 months were enrolled for intravenous iron (IVFE) supplementation (100 mg of iron polymaltose 3 times/wk for 4 weeks, then 100 mg every 2 weeks for 5 months). Routine iron tests (ie, serum ferritin and transferrin saturation [TSAT]), TfR-F index calculated by the ratio of soluble TfR to log ferritin level, hematocrit, hemoglobin, red blood cell count, and serum high-sensitive C-reactive protein were examined at baseline. Hematocrit and hemoglobin were followed up every 2 weeks during the study period.

RESULTS

One hundred patients (52 men, 48 women; mean age, 59 years) completed this study. Fifty-two patients were IVFE responders, defined as an increase in hematocrit greater than 3% and/or a decrease in rHuEPO dose greater than 30% of baseline values at the end of the study, and 48 nonresponders did not fulfill these criteria. Of 52 responders, only 14 patients (27%) could be recognized for iron deficiency by means of routine iron tests (ferritin < 100 microg/L and/or TSAT < 20%). Thirty-three responders (63%) could be further identified for iron deficiency by using TfR-F index (> 0.6), but 5 (10%) still could not by either method. Analyses by using receiver operating characteristic (ROC) curves showed that a cutoff value greater than 0.6 for TfR-F index had greater sensitivity (90%) for the detection of iron deficiency than ferritin level less than 100 microg/L (29%) and TSAT less than 20% (6%). TfR-F index showed a greater area under the ROC curve than ferritin level (P < 0.05) and TSAT (P < 0.001).

CONCLUSION

TfR-F index is superior to routine tests for predicting response to IVFE supplementation in long-term HD patients. Our study indicates that TfR-F index is a new and surrogate marker to estimate body iron stores and guide IVFE therapy for long-term HD patients.

Authors+Show Affiliations

Institutes of Physiology and Clinical Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16731299

Citation

Chen, Yen-Cheng, et al. "Association Between Transferrin Receptor-ferritin Index and Conventional Measures of Iron Responsiveness in Hemodialysis Patients." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 47, no. 6, 2006, pp. 1036-44.
Chen YC, Hung SC, Tarng DC. Association between transferrin receptor-ferritin index and conventional measures of iron responsiveness in hemodialysis patients. Am J Kidney Dis. 2006;47(6):1036-44.
Chen, Y. C., Hung, S. C., & Tarng, D. C. (2006). Association between transferrin receptor-ferritin index and conventional measures of iron responsiveness in hemodialysis patients. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 47(6), 1036-44.
Chen YC, Hung SC, Tarng DC. Association Between Transferrin Receptor-ferritin Index and Conventional Measures of Iron Responsiveness in Hemodialysis Patients. Am J Kidney Dis. 2006;47(6):1036-44. PubMed PMID: 16731299.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between transferrin receptor-ferritin index and conventional measures of iron responsiveness in hemodialysis patients. AU - Chen,Yen-Cheng, AU - Hung,Szu-Chun, AU - Tarng,Der-Cherng, PY - 2005/10/18/received PY - 2006/02/22/accepted PY - 2006/5/30/pubmed PY - 2006/6/10/medline PY - 2006/5/30/entrez SP - 1036 EP - 44 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 47 IS - 6 N2 - BACKGROUND: The diagnostic power of the transferrin receptor-ferritin (TfR-F) index for identification of iron responsiveness in long-term hemodialysis (HD) patients compared with the routine markers recommended by the current US and European guidelines was appraised. METHODS: Initially, 121 long-term HD patients with a serum ferritin level less than 800 microg/L and on recombinant erythropoietin (rHuEPO) therapy for longer than 6 months were enrolled for intravenous iron (IVFE) supplementation (100 mg of iron polymaltose 3 times/wk for 4 weeks, then 100 mg every 2 weeks for 5 months). Routine iron tests (ie, serum ferritin and transferrin saturation [TSAT]), TfR-F index calculated by the ratio of soluble TfR to log ferritin level, hematocrit, hemoglobin, red blood cell count, and serum high-sensitive C-reactive protein were examined at baseline. Hematocrit and hemoglobin were followed up every 2 weeks during the study period. RESULTS: One hundred patients (52 men, 48 women; mean age, 59 years) completed this study. Fifty-two patients were IVFE responders, defined as an increase in hematocrit greater than 3% and/or a decrease in rHuEPO dose greater than 30% of baseline values at the end of the study, and 48 nonresponders did not fulfill these criteria. Of 52 responders, only 14 patients (27%) could be recognized for iron deficiency by means of routine iron tests (ferritin < 100 microg/L and/or TSAT < 20%). Thirty-three responders (63%) could be further identified for iron deficiency by using TfR-F index (> 0.6), but 5 (10%) still could not by either method. Analyses by using receiver operating characteristic (ROC) curves showed that a cutoff value greater than 0.6 for TfR-F index had greater sensitivity (90%) for the detection of iron deficiency than ferritin level less than 100 microg/L (29%) and TSAT less than 20% (6%). TfR-F index showed a greater area under the ROC curve than ferritin level (P < 0.05) and TSAT (P < 0.001). CONCLUSION: TfR-F index is superior to routine tests for predicting response to IVFE supplementation in long-term HD patients. Our study indicates that TfR-F index is a new and surrogate marker to estimate body iron stores and guide IVFE therapy for long-term HD patients. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16731299/Association_between_transferrin_receptor_ferritin_index_and_conventional_measures_of_iron_responsiveness_in_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(06)00437-9 DB - PRIME DP - Unbound Medicine ER -