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Experience with zinc protoporphyrin as a marker of endogenous iron availability in chronic haemodialysis patients.
Nephrol Dial Transplant. 1996 Mar; 11(3):486-91.ND

Abstract

BACKGROUND

Ferritin and the percentage of transferrin saturation (TS) are established parameters with which to evaluate endogenous iron availability during treatment of renal anaemia with recombinant human erythropoietin (rHuEpo). Zinc protoporphyrin (ZPP) has been proposed as another valid marker in this setting.

METHODS

We determined the following parameters in 127 patients, including 117 haemodialysis patients: haemoglobin, erythrocytes, haematocrit, mean corpuscular volume (MCV), iron, ferritin, transferrin saturation and ZPP. Of the patients treated in a cross-sectional study, 38.5% were treated with rHuEpo; 30.7% with intravenous iron; and 13.6% with intravenous iron and rHuEpo simultaneously. Median ferritin was 304 ng/ml and median transferrin saturation was 21.2%.

RESULTS

Including cases with manifest storage iron deficiency, a concordant elevated ZPP (> 40 mumol/mol haem) and a decreased transferrin saturation (< 20%) were found in 23 of our dialysis patients (19.6%) while 55 cases (47%) were classified as concordantly negative. However, as many as 39 cases (33.3%) showed discrepant results: in 16 cases (13.6%) ZPP was elevated but transferrin saturation was in the normal range, while in 23 cases (19.6%) the opposite results were observed.

CONCLUSIONS

We conclude that beyond the border of manifest storage iron deficiency, defined as a ferritin < 30 ng/ml in male and < 15 ng/ml in female patients, ZPP and TS cover different ranges of functional iron deficiency which is reflected in the lack of a correlation of ZPP to any other of the above-mentioned parameters. Our data suggest that a TS < 20% as a diagnostic, and thus intervention, criterion in the evaluation of functional iron deficiency and iron substitution beyond manifest storage iron deficiency might result in overestimation of iron requirements. It remains to be shown in a longitudinal study, also reflecting the course of haemoglobin and the mean rHuEpo dose, whether ZPP or TS is the more appropriate parameter in the evaluation of functional iron availability.

Authors+Show Affiliations

Baldus M
Medizinische Klinik A, Ludwigshafen am Rhein, Germany.
Salopek S
No affiliation info available
Möller M
No affiliation info available
Schliesser J
No affiliation info available
Klooker P
No affiliation info available
Reddig J
No affiliation info available
Gansert U
No affiliation info available
Brass H
No affiliation info available

MeSH

AdultAgedAged, 80 and overAnemia, Iron-DeficiencyBiomarkersCross-Sectional StudiesDrug Therapy, CombinationEnzyme InhibitorsErythrocyte CountErythropoietinFemaleFerritinsHematocritHeme Oxygenase (Decyclizing)HemoglobinsHumansInfusions, IntravenousIronKidney Failure, ChronicMaleMiddle AgedProtoporphyrinsRecombinant ProteinsRenal DialysisTransferrin

Pub Type(s)

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

Language

eng

PubMed ID

8710158

Citation

Baldus, M, et al. "Experience With Zinc Protoporphyrin as a Marker of Endogenous Iron Availability in Chronic Haemodialysis Patients." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 11, no. 3, 1996, pp. 486-91.
Baldus M, Salopek S, Möller M, et al. Experience with zinc protoporphyrin as a marker of endogenous iron availability in chronic haemodialysis patients. Nephrol Dial Transplant. 1996;11(3):486-91.
Baldus, M., Salopek, S., Möller, M., Schliesser, J., Klooker, P., Reddig, J., Gansert, U., & Brass, H. (1996). Experience with zinc protoporphyrin as a marker of endogenous iron availability in chronic haemodialysis patients. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 11(3), 486-91.
Baldus M, et al. Experience With Zinc Protoporphyrin as a Marker of Endogenous Iron Availability in Chronic Haemodialysis Patients. Nephrol Dial Transplant. 1996;11(3):486-91. PubMed PMID: 8710158.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Experience with zinc protoporphyrin as a marker of endogenous iron availability in chronic haemodialysis patients. AU - Baldus,M, AU - Salopek,S, AU - Möller,M, AU - Schliesser,J, AU - Klooker,P, AU - Reddig,J, AU - Gansert,U, AU - Brass,H, PY - 1996/3/1/pubmed PY - 1996/3/1/medline PY - 1996/3/1/entrez SP - 486 EP - 91 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 11 IS - 3 N2 - BACKGROUND: Ferritin and the percentage of transferrin saturation (TS) are established parameters with which to evaluate endogenous iron availability during treatment of renal anaemia with recombinant human erythropoietin (rHuEpo). Zinc protoporphyrin (ZPP) has been proposed as another valid marker in this setting. METHODS: We determined the following parameters in 127 patients, including 117 haemodialysis patients: haemoglobin, erythrocytes, haematocrit, mean corpuscular volume (MCV), iron, ferritin, transferrin saturation and ZPP. Of the patients treated in a cross-sectional study, 38.5% were treated with rHuEpo; 30.7% with intravenous iron; and 13.6% with intravenous iron and rHuEpo simultaneously. Median ferritin was 304 ng/ml and median transferrin saturation was 21.2%. RESULTS: Including cases with manifest storage iron deficiency, a concordant elevated ZPP (> 40 mumol/mol haem) and a decreased transferrin saturation (< 20%) were found in 23 of our dialysis patients (19.6%) while 55 cases (47%) were classified as concordantly negative. However, as many as 39 cases (33.3%) showed discrepant results: in 16 cases (13.6%) ZPP was elevated but transferrin saturation was in the normal range, while in 23 cases (19.6%) the opposite results were observed. CONCLUSIONS: We conclude that beyond the border of manifest storage iron deficiency, defined as a ferritin < 30 ng/ml in male and < 15 ng/ml in female patients, ZPP and TS cover different ranges of functional iron deficiency which is reflected in the lack of a correlation of ZPP to any other of the above-mentioned parameters. Our data suggest that a TS < 20% as a diagnostic, and thus intervention, criterion in the evaluation of functional iron deficiency and iron substitution beyond manifest storage iron deficiency might result in overestimation of iron requirements. It remains to be shown in a longitudinal study, also reflecting the course of haemoglobin and the mean rHuEpo dose, whether ZPP or TS is the more appropriate parameter in the evaluation of functional iron availability. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/8710158/Experience_with_zinc_protoporphyrin_as_a_marker_of_endogenous_iron_availability_in_chronic_haemodialysis_patients_ L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -