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Role of C-reactive protein, reticulocyte haemoglobin content and inflammatory markers in iron and erythropoietin administration in dialysis patients.
Nephrology (Carlton). 2006 Oct; 11(5):400-4.N

Abstract

AIM

C-reactive protein (CRP) is an acute phase reactant protein, which becomes elevated in response to inflammation, infections or malignancies. These conditions are well known causes of bone marrow hyporesponsiveness and erythropoietin resistance in dialysis patients. The role of iron-deficiency as a cause of hyporesponsiveness under these conditions is not clear. Reticulocyte haemoglobin content (CHr) is one of several iron indices used to determine iron deficiency in dialysis patients. The aim of this study is to evaluate the role of CRP and CHr in iron administration and anaemia management in dialysis patients.

METHODS

In 47 haemodialysis patients with ferritin levels of >500 ng/mL, CRP, CHr, transferrin saturation (TSAT), other markers and erythropoietin dose were evaluated. Patients with CRP < 5 mg/L (Group A) were compared to patients with CRP > 5 mg/L (Group B).

RESULTS

Ferritin levels in the two groups were not different. Weekly erythropoietin was significantly different between the two groups. Group B required an average of 121% more erythropoietin than Group A to maintain similar haemoglobin levels of 11-12 g/dL 36% of Group B had CHr < 29 pg versus 7% of patients in Group A. 39% of patients in Group B also had TSAT < 20% versus 0% in Group A. Group A also had more arteriovenous (AV) fistulae as dialysis access than group B.

CONCLUSION

Data indicate that low CHr, similar to low TSAT, could be associated with inflammatory process and erythropoietin resistance, but not necessarily with iron-deficiency. High CRP association with low CHr and low TSAT levels can explain the lack of response to further IV iron therapy. AV grafts, contrary to AV fistulae, are associated with high inflammatory markers and also with a higher erythropoietin requirement.

Authors+Show Affiliations

University of Cincinnati College of Medicine, Division Of Nephrology and Hypertension, Department of Internal Medicine, Cincinnati, Ohio 45267-0585, USA. mahmoud.elkhatib@uc.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17014552

Citation

El-Khatib, Mahmoud, et al. "Role of C-reactive Protein, Reticulocyte Haemoglobin Content and Inflammatory Markers in Iron and Erythropoietin Administration in Dialysis Patients." Nephrology (Carlton, Vic.), vol. 11, no. 5, 2006, pp. 400-4.
El-Khatib M, Duncan HJ, Kant KS. Role of C-reactive protein, reticulocyte haemoglobin content and inflammatory markers in iron and erythropoietin administration in dialysis patients. Nephrology (Carlton). 2006;11(5):400-4.
El-Khatib, M., Duncan, H. J., & Kant, K. S. (2006). Role of C-reactive protein, reticulocyte haemoglobin content and inflammatory markers in iron and erythropoietin administration in dialysis patients. Nephrology (Carlton, Vic.), 11(5), 400-4.
El-Khatib M, Duncan HJ, Kant KS. Role of C-reactive Protein, Reticulocyte Haemoglobin Content and Inflammatory Markers in Iron and Erythropoietin Administration in Dialysis Patients. Nephrology (Carlton). 2006;11(5):400-4. PubMed PMID: 17014552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of C-reactive protein, reticulocyte haemoglobin content and inflammatory markers in iron and erythropoietin administration in dialysis patients. AU - El-Khatib,Mahmoud, AU - Duncan,Heather J, AU - Kant,K Shashi, PY - 2006/10/4/pubmed PY - 2007/1/19/medline PY - 2006/10/4/entrez SP - 400 EP - 4 JF - Nephrology (Carlton, Vic.) JO - Nephrology (Carlton) VL - 11 IS - 5 N2 - AIM: C-reactive protein (CRP) is an acute phase reactant protein, which becomes elevated in response to inflammation, infections or malignancies. These conditions are well known causes of bone marrow hyporesponsiveness and erythropoietin resistance in dialysis patients. The role of iron-deficiency as a cause of hyporesponsiveness under these conditions is not clear. Reticulocyte haemoglobin content (CHr) is one of several iron indices used to determine iron deficiency in dialysis patients. The aim of this study is to evaluate the role of CRP and CHr in iron administration and anaemia management in dialysis patients. METHODS: In 47 haemodialysis patients with ferritin levels of >500 ng/mL, CRP, CHr, transferrin saturation (TSAT), other markers and erythropoietin dose were evaluated. Patients with CRP < 5 mg/L (Group A) were compared to patients with CRP > 5 mg/L (Group B). RESULTS: Ferritin levels in the two groups were not different. Weekly erythropoietin was significantly different between the two groups. Group B required an average of 121% more erythropoietin than Group A to maintain similar haemoglobin levels of 11-12 g/dL 36% of Group B had CHr < 29 pg versus 7% of patients in Group A. 39% of patients in Group B also had TSAT < 20% versus 0% in Group A. Group A also had more arteriovenous (AV) fistulae as dialysis access than group B. CONCLUSION: Data indicate that low CHr, similar to low TSAT, could be associated with inflammatory process and erythropoietin resistance, but not necessarily with iron-deficiency. High CRP association with low CHr and low TSAT levels can explain the lack of response to further IV iron therapy. AV grafts, contrary to AV fistulae, are associated with high inflammatory markers and also with a higher erythropoietin requirement. SN - 1320-5358 UR - https://www.unboundmedicine.com/medline/citation/17014552/Role_of_C_reactive_protein_reticulocyte_haemoglobin_content_and_inflammatory_markers_in_iron_and_erythropoietin_administration_in_dialysis_patients_ L2 - https://doi.org/10.1111/j.1440-1797.2006.00676.x DB - PRIME DP - Unbound Medicine ER -